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Dax F, Trentzsch H, Lazarovici M, Hegenberg K, Kneißl K, Hoffmann F, Prückner S. Ambulance deployment without transport: a retrospective difference analysis for the description of emergency interventions without patient transport in Bavaria. Scand J Trauma Resusc Emerg Med 2023; 31:93. [PMID: 38057935 DOI: 10.1186/s13049-023-01159-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/23/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Not all patients who call the ambulance service are subsequently transported to hospital. In 2018, a quarter of deployments of an emergency ambulance in Bavaria were not followed by patient transport. This study describes factors that influence patient transport rates. METHOD This is a retrospective cross-sectional study based on data from all Integrated Dispatch Centres of the Free State of Bavaria in 2018. Included were ambulance deployments without emergency physician involvement, which were subdivided into ambulance deployments without transport and ambulance deployments with transport. The proportion of transported patients were determined for the primary reasons for deployment and for the different community types. On-scene time was compared for calls with and without patient transport. Differences were tested for statistical significance using Chi2 tests and the odds ratio was calculated to determine differences between groups. RESULTS Of 510,145 deployments, 147,621 (28.9%) could be classified as ambulance deployments without transport and 362,524 (71.1%) as ambulance deployments with transport.The lowest proportion of patients transported was found for activations where the fire brigade was involved ("fire alarm system" 0.6%, "fire with emergency medical services" 5.4%) and "personal emergency response system active alarm" (18.6%). The highest transport rates were observed for emergencies involving "childbirth/delivery" (96.9%) and "trauma" (83.2%). A lower proportion of patients is transported in large cities as compared to smaller cities or rural communities; in large cities, the odds ratio for emergencies without transport is 2.02 [95% confidence interval 1.98-2.06] referenced to rural communites. The median on-scene time for emergencies without transport was 20.8 min (n = 141,052) as compared to 16.5 min for emergencies with transport (n = 362,524). The shortest on-scene times for emergencies without transport were identified for activations related to "fire alarm system" (9.0 min) and "personal emergency response system active alarm" (10.6 min). CONCLUSION This study indicates that the proportion of patients transported depends on the reason for deployment and whether the emergency location is urban or rural. Particularly low transport rates are found if an ambulance was dispatched in connection with a fire department operation or a personal emergency medical alert button was activated. The on-scene-time of the rescue vehicle is increased for deployments without transport. The study could not provide a rationale for this and further research is needed. Trial registration This paper is part of the study "Rettungswageneinsatz ohne Transport" ["Ambulance deployment without transport"] (RoT), which was registered in the German Register of Clinical Studies under the number DRKS00017758.
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Affiliation(s)
- Florian Dax
- Institut Für Notfallmedizin und Medizinmanagement (INM), University Hospital Munich, LMU Munich, Schillerstr. 53, 80336, Munich, Germany.
| | - Heiko Trentzsch
- Institut Für Notfallmedizin und Medizinmanagement (INM), University Hospital Munich, LMU Munich, Schillerstr. 53, 80336, Munich, Germany
| | - Marc Lazarovici
- Institut Für Notfallmedizin und Medizinmanagement (INM), University Hospital Munich, LMU Munich, Schillerstr. 53, 80336, Munich, Germany
| | - Kathrin Hegenberg
- Institut Für Notfallmedizin und Medizinmanagement (INM), University Hospital Munich, LMU Munich, Schillerstr. 53, 80336, Munich, Germany
| | - Katharina Kneißl
- Institut Für Notfallmedizin und Medizinmanagement (INM), University Hospital Munich, LMU Munich, Schillerstr. 53, 80336, Munich, Germany
| | - Florian Hoffmann
- Dr. Von Haunersches Kinderspital, Paediatric Clinic and Polyclinic, University Hospital Munich, LMU Munich, Lindwurmstr. 4, 80337, Munich, Germany
| | - Stephan Prückner
- Institut Für Notfallmedizin und Medizinmanagement (INM), University Hospital Munich, LMU Munich, Schillerstr. 53, 80336, Munich, Germany.
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Deguchi R, Katayama Y, Himura H, Nishimura T, Nakagawa Y, Kitamura T, Tai S, Tsujino J, Shimazu T, Mizobata Y. Telephone triage service use is associated with better outcomes among patients with cerebrovascular diseases: a propensity score analysis using population-based data. Front Public Health 2023; 11:1175479. [PMID: 37351090 PMCID: PMC10282134 DOI: 10.3389/fpubh.2023.1175479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
Introduction The telephone triage service is an emergency medical system through which citizens consult telephone triage nurses regarding illness, and the nurses determine the urgency and need for an ambulance. Despite being introduced in several countries, its impact on emergency patients has not been reported. We aimed to determine the effect of the telephone triage service on the outcomes of hospitalized patients diagnosed with cerebrovascular disease upon arrival after being transported by an ambulance. Methods This retrospective study included patients with cerebrovascular disease who were transported by ambulance between January 2016 and December 2019. The primary outcome was discharge to home by day 21 of hospitalization. A total of 344 patients who used the telephone triage service were propensity score-matched to 344 patients who directly called for an ambulance. Results Telephone triage service use was associated with discharge to home by hospital day 21 (crude odd ratio: 1.8; 95% confidence interval: 1.3-2.4) and was not significantly associated with survival on hospital day 21 in multivariate regression analysis. Conclusion The prognoses of cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage depend on the time from symptom onset to treatment. Telephone triage services may allow patients to receive treatment more rapidly than traditional ambulance requests, resulting in improved patient outcomes. The findings of this study suggest that the use of telephone triage services is associated with improved outcomes in patients with cerebrovascular disease and indicate that the costs for medical expenses and disability may be greatly reduced in an aging society.
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Affiliation(s)
- Ryo Deguchi
- Department of Traumatology and Critical Care Medicine, Osaka Metropolitan Graduate School of Medicine, Osaka, Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hoshi Himura
- Department of Traumatology and Critical Care Medicine, Osaka Metropolitan Graduate School of Medicine, Osaka, Japan
| | - Tetsuro Nishimura
- Department of Traumatology and Critical Care Medicine, Osaka Metropolitan Graduate School of Medicine, Osaka, Japan
| | - Yuko Nakagawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | | | | | | | - Yasumitsu Mizobata
- Department of Traumatology and Critical Care Medicine, Osaka Metropolitan Graduate School of Medicine, Osaka, Japan
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Greene JA, Goldstein J, Stirling J, Swain JM, Brown R, McVey J, Carter A. Clinical Roles in the Medical Communications Centre: A Rapid Scoping Review. Cureus 2023; 15:e39441. [PMID: 37362545 PMCID: PMC10289204 DOI: 10.7759/cureus.39441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
In recent years, 911 call volumes have increased, and emergency medical services (EMS) are routinely stretched beyond capacity. To better match resources with patient needs, some EMS systems have integrated clinician roles into the emergency medical communications centre (MCC). Our objective was to explore the nature and scope of clinical roles in emergency MCCs. Using a rapid scoping review methodology, we searched PubMed for studies related to any clinical role employed within an emergency MCC. We accepted reviews, experimental and observational designs, as well as expert opinions. Studies reporting on dispatcher recognition and pre-arrival instructions were excluded. Title and abstract screening were conducted by a single reviewer, included studies were verified by two reviewers, and data extraction was completed in duplicate, all using Covidence review software. The level of evidence was assessed using the prehospital evidence-based practice (PEP) scale. The protocol was registered in Open Science Framework (10.17605/OSF.IO/NX4T8). Our search yielded 1071 titles, and four were added from other sources; 44 studies were reviewed at the full-text stage and 31 were included. The included studies were published from 2002 to 2022 and represent 17 countries. Studies meeting inclusion criteria consisted of level I (n=4, 11%), II (n=13, 37%), and III (N=6, 17%) methodologies, as well as 12 other studies (34%) with qualitative or other designs. Most of the included studies reported systems that employ nurses in the MCC (n=29, 83%). Twelve (34%) studies reported on the inclusion of paramedics in the MCC, and five (14%) reported physician involvement. The roles of these clinicians chiefly consisted of triage (n=25, 71%), advice (n=20, 57%), referral to non-emergency care (n=14, 40%), and peer-to-peer consulting (n=2, 4%). Alternative dispositions (as opposed to emergency ambulance transport) for low acuity callers included self-care, as well as referral to a general practitioner, pharmacist, or other outreach programs. There is a wide range of literature reporting on clinical roles integrated within MCCs. Our findings revealed that MCC nurses, physicians, and paramedics assist substantively with triage, advice, and referrals to better match resources to patient needs, with or without the requirement for ambulance dispatch.
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Affiliation(s)
| | | | | | - Janel M Swain
- Emergency Health Services, Nova Scotia, Dartmouth, CAN
| | - Ryan Brown
- Interprofessional Practice and Learning, Nova Scotia Health, Sydney, CAN
- Emergency Medicine, Dalhousie University, Halifax, CAN
| | | | - Alix Carter
- Emergency Medicine, Dalhousie University, Halifax, CAN
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Katayama Y, Kitamura T, Nakao S, Tanaka K, Himura H, Deguchi R, Tai S, Tsujino J, Mizobata Y, Shimazu T, Nakagawa Y. Association of a telephone triage service for emergency patients with better outcome: a population-based study in Osaka City, Japan. Eur J Emerg Med 2022; 29:262-270. [PMID: 35148526 PMCID: PMC9241652 DOI: 10.1097/mej.0000000000000902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Telephone triage service in emergency care has been introduced in many countries, and it is important to determine the effect of telephone triage service on the outcome of emergency patients. The aim of this study was to evaluate the effect of telephone triage service on the outcome of emergency patients using propensity score. METHODS DESIGN, SETTINGS, AND PARTICIPANTS This was a retrospective study with a study period from January 2016 to December 2019. We included all patients transported by ambulances of the Osaka Municipal Fire Department during study period. EXPOSURE Telephone triage service. OUTCOME MEASURES AND ANALYSIS The main outcome of this study was unfavorable outcome following use of the telephone triage service. In this study, unfavorable outcome was defined as patients who were admitted, transferred, or died after care in the emergency department. Propensity scores were calculated using a logistic regression model with 12 variables that were present before the telephone triage service was used or were indicative of the patient's condition. Data analyses were not only propensity score matching but also a multivariable logistic regression model and regression model with propensity score as a covariate. MAIN RESULTS The number of patients eligible for analyses was 707 474. Of these patients, 8008 (1.0%) used the telephone triage services and 699 466 patients (99.0%) did not use it. The number of patients with an unfavorable outcome was 407 568 (57.6%) in the total cohort. Of them, 2305 patients (28.8%) used the telephone triage service and 297 601 patients (42.5%) did not use it. For propensity score matching, 8008 patients were matched from each group. Use of the telephone triage service was inversely associated with unfavorable outcome in a multivariate logistic regression model with propensity score as a covariate [adjusted odds ratio (OR) 0.874; 95% confidence interval (CI), 0.831-0.919] and propensity score matching (crude OR, 0.875; 95% CI, 0.818-0.936). CONCLUSIONS This study revealed that the use of the telephone triage service in Osaka city, Japan was associated with better outcomes of patients transported by ambulance.
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Affiliation(s)
| | | | | | - Kenta Tanaka
- Department of Traumatology and Acute Critical Medicine
| | - Hoshi Himura
- Department of Traumatology and Acute Critical Medicine
| | - Ryo Deguchi
- Department of Traumatology and Acute Critical Medicine
| | - Shunsuke Tai
- Department of Traumatology and Acute Critical Medicine
| | - Junya Tsujino
- Department of Traumatology and Acute Critical Medicine
| | | | | | - Yuko Nakagawa
- Department of Traumatology and Acute Critical Medicine
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Katayama Y, Kitamura T, Nakao S, Himura H, Deguchi R, Tai S, Tsujino J, Mizobata Y, Shimazu T, Nakagawa Y. Telephone Triage for Emergency Patients Reduces Unnecessary Ambulance Use: A Propensity Score Analysis With Population-Based Data in Osaka City, Japan. Front Public Health 2022; 10:896506. [PMID: 35844882 PMCID: PMC9277563 DOI: 10.3389/fpubh.2022.896506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Telephone triage service in emergency care has been introduced around the world, but the impact of this service on the emergency medical service (EMS) system has not been fully revealed. The aim of this study was to evaluate the effect of telephone triage service for emergency patients on decreasing unnecessary ambulance use by analysis with propensity score (PS) matching. Methods This study was a retrospective observational study, and the study period was the 4 years from January 2016 to December 2019. We included cases for which ambulances were dispatched from the Osaka Municipal Fire Department (OMFD). The primary outcome of this study was unnecessary ambulance use. We calculated a PS by fitting a logistic regression model to adjust for 10 variables that existed before use of the telephone triage service. To ensure the robustness of this analysis, we used not only PS matching but also a multivariable logistic regression model and regression model with PS as a covariate. Results This study included 868,548 cases, of which 8,828 (1.0%) used telephone triage services and 859,720 (99.0%) did not use this service. Use of the telephone triage service was inversely associated with the occurrence of unnecessary ambulance use in multivariate logistic regression model (adjusted OR 0.453, 95% CI 0.405–0.506) and multivariate logistic regression model with PS as a covariate (adjusted OR 0.514, 95% CI 0.460–0.574). In the PS matching model, we also revealed same results (crude OR 0.487, 95% CI 0.425–0.588). Conclusions In this study, we were able to statistically evaluate the effectiveness of telephone triage service already in use by the public using the statistical method with PS. As a result, it was revealed that the use of a telephone triage service was associated with a lower proportion of unnecessary ambulance use in a metropolitan area of Japan.
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Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- *Correspondence: Yusuke Katayama
| | - Tetsuhisa Kitamura
- Department of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hoshi Himura
- Department of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ryo Deguchi
- Department of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | | | - Yasumitsu Mizobata
- Department of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Yuko Nakagawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Miller M, Bootland D, Jorm L, Gallego B. Improving ambulance dispatch triage to trauma: A scoping review using the framework of development and evaluation of clinical prediction rules. Injury 2022; 53:1746-1755. [PMID: 35321793 DOI: 10.1016/j.injury.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Ambulance dispatch algorithms should function as clinical prediction rules, identifying high acuity patients for advanced life support, and low acuity patients for non-urgent transport. Systematic reviews of dispatch algorithms are rare and focus on study types specific to the final phases of rule development, such as impact studies, and may miss the complete value-added evidence chain. We sought to summarise the literature for studies seeking to improve dispatch in trauma by performing a scoping review according to standard frameworks for developing and evaluating clinical prediction rules. METHODS We performed a scoping review searching MEDLINE, EMBASE, CINAHL, the CENTRAL trials registry, and grey literature from January 2005 to October 2021. We included all study types investigating dispatch triage to injured patients in the English language. We reported the clinical prediction rule phase (derivation, validation, impact analysis, or user acceptance) and the performance and outcomes measured for high and low acuity trauma patients. RESULTS Of 2067 papers screened, we identified 12 low and 30 high acuity studies. Derivation studies were most common (52%) and rule-based computer-aided dispatch was the most frequently investigated (23 studies). Impact studies rarely reported a prior validation phase, and few validation studies had their impact investigated. Common outcome measures in each phase were infrequent (0 to 27%), making a comparison between protocols difficult. A series of papers for low acuity patients and another for pediatric trauma followed clinical prediction rule development. Some low acuity Medical Priority Dispatch System codes are associated with the infrequent requirement for advanced life support and clinician review of computer-aided dispatch may enhance dispatch triage accuracy in studies of helicopter emergency medical services. CONCLUSIONS Few derivation and validation studies were followed by an impact study, indicating important gaps in the value-added evidence chain. While impact studies suggest clinician oversight may enhance dispatch, the opportunity exists to standardize outcomes, identify trauma-specific low acuity codes, and develop intelligent dispatch systems.
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Affiliation(s)
- Matthew Miller
- Department of Anesthesia, St George Hospital, Kogarah, Sydney, Australia; Aeromedical Operations, New South Wales Ambulance, Rozelle, Sydney, Australia; PhD Candidate, Centre for Big Data Research in Health at UNSW Sydney, Australia.
| | - Duncan Bootland
- Medical Director, Air Ambulance Kent Surrey Sussex; Department of emergency medicine, University Hospitals Sussex, Brighton, UK
| | - Louisa Jorm
- Professor, Foundation Director of the Centre for Big Data Research in Health at UNSW Sydney
| | - Blanca Gallego
- Associate Professor, Clinical analytics and machine learning unit, Centre for Big Data Research in Health, UNSW, Sydney
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Roivainen P, Hoikka MJ, Ala-Kokko TI, Kääriäinen M. Patient satisfaction with telephone care assessment among patients with non-urgent prehospital emergency care issues: A cross-sectional study. Int Emerg Nurs 2021; 59:101070. [PMID: 34592607 DOI: 10.1016/j.ienj.2021.101070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 07/17/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Telephone care assessment (TCA) by a nurse have shown to reduce the number of emergency department (ED) visits and emergency medical services missions (EMS). The present study aimed to describe satisfaction among patients with non-urgent prehospital medical issues that were transferred to TCA instead of receiving EMS. These results could provide a basis for developing the telephone services and emergency care pathways. METHODS This cross-sectional study included 765 patients with non-urgent issues that were transferred to a telephone care assessment, after a risk and urgency assessment by an emergency medical communications operator. One week later, patient satisfaction was evaluated in a structured telephone interview with randomized patients. RESULTS 127 telephone interviews were completed.Most patients (70.9-85.0%) were highly satisfied with the telephone care assessment. In particular,patients who were unsure of the urgency of their own health condition and the need for EMS, were highly satisfied (95.3%). Patients that received EMS after the telephone care assessment were more satisfied than those that received telephone guidance or those directed to other health care services (91.4% vs. 65.5% vs. 67.9%, p = 0.002). CONCLUSION Patients with non-urgent prehospital emergency issues were mainly satisfied with telephone care assessment. In considering ways to reduce the increasing load on emergency medical services, a telephone care assessment could be a good option, without reducing patient satisfaction.
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Affiliation(s)
- P Roivainen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.
| | - M J Hoikka
- Emergency Medical Services, Kainuu Central Hospital, Sotkamontie 13, 87300 Kajaani, Finland.
| | - T I Ala-Kokko
- Research Group of Surgery, Anaesthesia and Intensive Care Medicine, University of Oulu, Medical Research Center, Division of Intensive Care, Oulu University Hospital, PO Box 21, 90029 Oulu, Finland.
| | - M Kääriäinen
- Faculty of Medicine, Research Unit of Nursing Science and Health Management, University of Oulu, Medical Research Center, Oulu University Hospital, Finland.
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Katayama Y, Kitamura T, Hirose T, Kiyohara K, Ishida K, Tachino J, Nakao S, Kiguchi T, Umemura Y, Noda T, Tai S, Tsujino J, Masui J, Mizobata Y, Shimazu T. Characteristics and outcome of patients triaged by telephone and transported by ambulance: a population-based study in Osaka, Japan. Acute Med Surg 2020; 7:e609. [PMID: 33282318 PMCID: PMC7700103 DOI: 10.1002/ams2.609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/22/2022] Open
Abstract
Aim Details such as diagnosis and outcome of patients transported by ambulance after telephone triage have not been fully revealed. The aim of this study was to reveal profile and outcome about patients transported by ambulance via telephone triage with dataset of telephone triage and population‐based registry for emergency patients. Methods This retrospective descriptive study with a one‐year study period from January 1, 2016 to December 31, 2016 included patients selected from the telephone triage dataset who were transported by ambulance. Key parameters such as age, sex and date and time of ambulance dispatch were used to identify patient data from the ORION registry. We assessed the profile and outcome of the patients in a descriptive epidemiological analysis. Results We included 4,293 patients in the selected datasets whose data were merged, of whom 2,998 patients (69.8%) returned home from the emergency department, 1,255 (29.2%) were hospitalized, 32 (0.7%) were transferred to other hospitals, and 8 (0.2%) died. The most common diagnosis in the emergency departments was “infectious gastroenteritis and colitis, unspecified [A09] (219, 5.1%)”. Among the 1,255 hospitalized patients, 905 patients (72.1%) were discharged home, 254 patients (20.2%) remained hospitalized, 52 patients (4.1%) were transferred to other hospitals, 38 patients (3.0%) died, and 5 patients (0.5%) had missing data. The most common diagnosis was “cerebral infarction [I63.0‐I63.9] (138, 11.0%)”. Conclusion This study revealed the profile and outcome of patients transported by ambulance after telephone triage.
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Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences Department of Social and Environmental Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Kosuke Kiyohara
- Department of Food Science Faculty of Home Economics Otsuma Women's University Tokyo Japan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical Center Osaka National Hospital National Hospital Organization Osaka Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Takeyuki Kiguchi
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan.,Kyoto University Health Services Kyoto Japan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan.,Kyoto University Health Services Kyoto Japan
| | - Tomohiro Noda
- Department of Traumatology and Critical Care Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | | | | | - Jun Masui
- Osaka Prefectural Government Osaka Japan
| | - Yasumitsu Mizobata
- Department of Traumatology and Critical Care Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
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Roivainen P, Hoikka MJ, Raatiniemi L, Silfvast T, Ala‐Kokko T, Kääriäinen M. Telephone triage performed by nurses reduces non-urgent ambulance missions: A prospective observational pilot study in Finland. Acta Anaesthesiol Scand 2020; 64:556-563. [PMID: 31898315 DOI: 10.1111/aas.13542] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The increased workload in emergency medical services (EMS) is a global phenomenon in welfare states. It has been suggested that telephone triage by nurses may reduce the increasing use of EMS services, by directing patient flow to appropriate care. This study aimed to investigate whether, after an emergency medical communication centre (EMCC) provider assessed risk, a telephone nurse could assess the patient's needs and guide patients to social and health care services in non-urgent cases. METHODS This prospective observational study was performed in the Kainuu Hospital District in northern Finland from March to April 2018. All EMS requests classified as non-urgent by the EMCC were transferred to a telephone triage nurse. Subsequent patient guidance was recorded. The International Classifications of Primary Care categories were recorded. RESULTS We studied phone calls of 700 patients with non-urgent needs. Of these, the nurse transferred 63.7% to EMS and 17.3% were guided to other social and health care services. Nineteen per cent of the calls were handled over the phone by the nurse, who provided health advice and instructions. The most common needs for care were general and unspecified symptoms, musculoskeletal symptoms, mental health problems and substance abuse. CONCLUSION By providing telephone counseling, care instructions and patient guidance to other social and health services than EMS, the telephone triage reduced non-urgent EMS missions by one third. The results imply that telephone triage could be a viable model for managing non-urgent missions. Patient safety issues should be monitored when developing new service concepts.
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Affiliation(s)
- Petri Roivainen
- Research Unit of Nursing Science and Health Management University of Oulu Oulu Finland
| | - Marko J. Hoikka
- Emergency Medical Services Kainuu Central Hospital Kajaani Finland
| | - Lasse Raatiniemi
- Centre for Pre‐Hospital Emergency Care Oulu University Hospital Oulu Finland
- Anaesthesia Research group MRC Oulu University Hospital and University of Oulu Oulu Finland
| | - Tom Silfvast
- Department of Anaesthesiology and Intensive Care University of Helsinki Helsinki University Central Hospital Helsinki Finland
| | - Tero Ala‐Kokko
- Research Group of Surgery, Anaesthesia and Intensive Care Medicine University of Oulu Medical Research Center Division of Intensive Care Oulu University Hospital Oulu Finland
| | - Maria Kääriäinen
- Faculty of Medicine Research Unit of Nursing Science and Health Management University of Oulu Medical Research Centre University Hospital of Oulu Oulu Finland
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Abstract
There are 240 million 9-1-1 calls in the United States every year. The burden of managing these emergencies until first responders can arrive is on the dispatchers working in the 5806 public safety answering points, more commonly known as dispatch centers. They are the first link in the chain of survival between the public and the remainder of the health care system. Dispatchers play a critical role in the early identification of emergencies, assignment of appropriate emergency resources, and provision of life-sustaining interventions like dispatcher-assisted cardiopulmonary resuscitation and disaster management.
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Affiliation(s)
- Saman Kashani
- Los Angeles Fire Department, EMS Bureau, 200 North Main Street, Suite 1860, Los Angeles, CA 90012, USA; Division of Emergency Medical Services, Department of Emergency Medicine, Keck School of Medicine of USC, 1200 North State Street, Room 1011, Los Angeles, CA 90033, USA.
| | - Stephen Sanko
- Los Angeles Fire Department, EMS Bureau, 200 North Main Street, Suite 1860, Los Angeles, CA 90012, USA; Division of Emergency Medical Services, Department of Emergency Medicine, Keck School of Medicine of USC, 1200 North State Street, Room 1011, Los Angeles, CA 90033, USA
| | - Marc Eckstein
- Los Angeles Fire Department, EMS Bureau, 200 North Main Street, Suite 1860, Los Angeles, CA 90012, USA; Division of Emergency Medical Services, Department of Emergency Medicine, Keck School of Medicine of USC, 1200 North State Street, Room 1011, Los Angeles, CA 90033, USA
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Impact of the Use of Regional Poison Control Centers in an Urban EMS Dispatch System. J Med Toxicol 2017; 13:47-51. [DOI: 10.1007/s13181-016-0586-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 11/27/2022] Open
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Turner J, Coster J, Chambers D, Cantrell A, Phung VH, Knowles E, Bradbury D, Goyder E. What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03430] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.
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Affiliation(s)
- Janette Turner
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Viet-Hai Phung
- College of Social Science, University of Lincoln, Lincoln, UK
| | - Emma Knowles
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes. CAN J EMERG MED 2015; 17:532-50. [DOI: 10.1017/cem.2014.59] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesEmergency medical services (EMS) programs, which provide an alternative to traditional EMS dispatch or transport to the emergency department (ED), are becoming widely implemented. This scoping review identified and catalogued all outcomes used to measure such alternative EMS programs.Data SourceBroad systematized bibliographic and grey literature searches were conducted.Study SelectionInclusion criteria were 911 callers/EMS patients, reported on alternatives to traditional EMS dispatch OR traditional EMS transport to the ED, and reported an outcome measure.Data ExtractionThe reports were categorized as either alternative to dispatch or to EMS transport, and outcome measures were categorized and described.Data SynthesisThe bibliographic search retrieved 13,215 records, of which 34 articles met the inclusion criteria, with an additional 10 added from reference list hand-searching (n=44 included). In the grey literature search, 31 websites were identified, from which four met criteria and were retrieved (n=4 included). Fifteen reports (16 studies) described alternatives to EMS dispatch, and 33 reports described alternatives to EMS transport. The most common outcomes reported in the alternatives to EMS dispatch reports were service utilization and decision accuracy. Twenty-four different specific outcomes were reported. The most common outcomes reported in the alternatives to EMS transport reports were service utilization and safety, and 50 different specific outcomes were reported.ConclusionsNumerous outcome measures were identified in reports of alternative EMS programs, which were catalogued and described. Researchers and program leaders should achieve consensus on uniform outcome measures, to allow benchmarking and improve comparison across programs.
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