Safety of telephone consultation for "non-serious" emergency ambulance service patients
Dale, Jeremy, Williams, S., Foster, T., Higgins, J., Snooks, Helen, Crouch, R., Hartley-Sharpe, C., Glucksman, E. and George, S.. (2004) Safety of telephone consultation for "non-serious" emergency ambulance service patients. BMJ Quality and Safety, Vol.13 (No.5). pp. 363-373. ISSN 2044-5423
WRAP_Dale_Telephone_consultation.pdf - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Official URL: http://dx.doi.org/10.1136/qshc.2003.008003
Objective: To assess the safety of nurses and paramedics offering telephone assessment, triage, and
advice as an alternative to immediate ambulance despatch for emergency ambulance service callers
classified by lay call takers as presenting with "non-serious" problems (category C calls).
Design: Data for this study were collected as part of a pragmatic randomised controlled trial reported
elsewhere. The intervention arm of the trial comprised nurse or paramedic telephone consultation using a
computerised decision support system to assess, triage, and advise patients whose calls to the emergency
ambulance service had been classified as "non-serious" by call takers applying standard priority despatch
criteria. A multidisciplinary expert clinical panel reviewed data from ambulance service, accident and
emergency department, hospital inpatient and general practice records, and call transcripts for patients
triaged by nurses and paramedics into categories that indicated that despatch of an emergency
ambulance was unnecessary. All cases for which one or more members of the panel rated that an
emergency ambulance should have been despatched were re-reviewed by the entire panel for an
assessment of the "life risk" that might have resulted.
Setting: Ambulance services in London and the West Midlands, UK.
Study population: Of 635 category C patients assessed by nurses and paramedics, 330 (52%) cases that
had been triaged as not requiring an emergency ambulance were identified.
Main outcome measures: Assessment of safety of triage decisions.
Results: Sufficient data were available from the routine clinical records of 239 (72%) subjects to allow
review by the specialist panel. For 231 (96.7%) sets of case notes reviewed, the majority of the panel
concurred with the nurses’ or paramedics’ triage decision. Following secondary review of the records of
the remaining eight patients, only two were rated by the majority as having required an emergency
ambulance within 14 minutes. For neither of these did a majority of the panel consider that the patient
would have been at "life risk" without an emergency ambulance being immediately despatched.
However, the transcripts of these two calls indicated that the correct triage decision had been
communicated to the patient, which suggests that the triage decision had been incorrectly entered into the
decision support system.
Conclusions: Telephone advice may be a safe method of managing many category C callers to 999
ambulance services. A clinical trial of the full implementation of this intervention is needed, large enough to
exclude the possibility of rare adverse events.
|Item Type:||Journal Article|
|Subjects:||R Medicine > RA Public aspects of medicine|
|Divisions:||Faculty of Medicine > Warwick Medical School|
|Library of Congress Subject Headings (LCSH):||Telephone in medicine, Triage (Medicine) -- Great Britain, Ambulance service -- Great Britain, Emergency medicine -- Decision making -- Computer programs|
|Journal or Publication Title:||BMJ Quality and Safety|
|Page Range:||pp. 363-373|
|Access rights to Published version:||Open Access|
|Funder:||NHS Executive. Research and Development Directorate|
1 Snooks H, Williams S, Crouch R, et al. NHS emergency response to 999 calls:
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