Dale, Jeremy, 1958-, Higgins, J., Williams, S., Foster, T., Snooks, Helen, Crouch, R., Hartley-Sharpe, C., Glucksman, E., Hooper, R. and George, S. (Steve). (2003) Computer assisted assessment and advice for "non-serious" 999 ambulance service callers : the potential impact on ambulance despatch. Emergency Medicine Journal, Vol.20 (No.2). pp. 178-183. ISSN 1472-0205

Preview

PDF WRAP_Dale_Computer_Assisted_assessment.pdf - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader Download (192Kb)

Abstract

Objective: To investigate the potential impact for ambulance services of telephone assessment and triage for callers who present with non-serious problems (Category C calls) as classified by ambulance service call takers. Design: Pragmatic controlled trial. Calls identified using priority dispatch protocols as non-serious were allocated to intervention and control groups according to time of call. Ambulance dispatch occurred according to existing procedures. During intervention sessions, nurses or paramedics within the control room used a computerised decision support system to provide telephone assessment, triage and, if appropriate, offer advice to permit estimation of the potential impact on ambulance dispatch. Setting: Ambulance services in London and the West Midlands. Subjects: Patients for whom emergency calls were made to the ambulance services between April 1998 and May 1999 during four hour sessions sampled across all days of the week between 0700 and 2300. Main outcome measures: Triage decision, ambulance cancellation, attendance at an emergency department. Results: In total, there were 635 intervention calls and 611 controls. Of those in the intervention group, 330 (52.0%) were triaged as not requiring an emergency ambulance, and 119 (36.6%) of these did not attend an emergency department. This compares with 55 (18.1%) of those triaged by a nurse or paramedic as requiring an ambulance (odds ratio 2.62; 95% CI 1.78 to 3.85). Patients triaged as not requiring an emergency ambulance were less likely to be admitted to an inpatient bed (odds ratio 0.55; 95% CI 0.33 to 0.93), but even so 30 (9.2%) were admitted. Nurses were more likely than paramedics to triage calls into the groups classified as not requiring an ambulance. After controlling for age, case mix, time of day, day of week, season, and ambulance service, the results of a logistic regression analysis revealed that this difference was significant with an odds ratio for nurses:paramedics of 1.28 (95% CI 1.12 to 1.47). Conclusions: The findings indicate that telephone assessment of Category C calls identifies patients who are less likely to require emergency department care and that this could have a significant impact on emergency ambulance dispatch rates. Nurses were more likely than paramedics to assess calls as requiring an alternative response to emergency ambulance despatch, but the extent to which this relates to aspects of training and professional perspective is unclear. However, consideration should be given to the acceptability, reliability, and cost consequences of this intervention before it can be recommended for full evaluation.

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:	Emergency Medicine Journal
Publisher:	BMJ Group
ISSN:	1472-0205
Date:	2003
Volume:	Vol.20
Number:	No.2
Page Range:	pp. 178-183
Identification Number:	10.1136/emj.20.2.178
Status:	Peer Reviewed
Access rights to Published version:	Open Access
Funder:	NHS Executive. Research and Development Directorate
References:	1 Richards JR, Ferrall SJ. Inappropriate use of emergency medical services transport: comparison of provider and patient perspectives. Acad Emerg Med 1999;6:14–20. 2 Palazzo FF, Warner OJ, Harron M, et al. Misuse of the London ambulance service: how much and why? J Accid Emerg Med 1998;15:368–70. 3 Little GF, Barton D. Inappropriate use of the ambulance service. Eur J Emerg Med 1998;5:307–11. 4 Holm O, Berlac PA, Jensen PK, et al. Relevance of the 112-emergency calls among the clientele of the emergency department of the Herlev hospital admitting office. Ugeskr Laeger 1997;159:1749–51. 5 Chen JC, Bullard MJ, Liaw SJ. Ambulance use, misuse, and unmet needs in a developing emergency medical services system. Eur J Emerg Med 1996;3:73–8. 6 Billitier A, Moscati R, Janicke D, et al. A multi-site survey of factors contributing to medically unnecessary ambulance transports. Acad Emerg Med 1996;3:1046–52. 7 McLeay GF, Hamilton D, Bowie P. Emergency ambulance service: an accident and emergency audit. Medical Audit News 1995;5:137–8. 8 Brown E, Sindelar J. The emergent problem of ambulance misuse. Ann Emerg Med 1993;22:646–9. 9 Pennycook AG, Makeower RM, Morrison WG. Use of the emergency ambulance service to an inner city accident and emergency department—a comparison of general practitioner and ‘999’ calls. J R Soc Med 1991;84:726–7. 10 Gardner GJ. The use and abuse of the emergency ambulance service: some of the factors affecting the decision whether to call an emergency ambulance. Arch Emerg Med 1990;7:81–9. 11 Kongelf E, Lereim I, Hald K. Requests for ambulances for patients with acute diseases and injuries. Are ambulance services abused? Tidsskr Nor Laegeforen 1989;109:3447–51. 12 O’Leary C, Bury G, McCabe M, et al. Ambulance-user analysis in an accident and emergency department. Ir Med J 1987;80:422–3. 13 Rademaker AW, Powell DG, Read JH. Inappropriate use and unmet need in paramedic and nonparamedic ambulance systems. Ann Emerg Med 1987;16:553–6. 14 Morris DL, Cross AB. Is the emergency ambulance service abused? BMJ 1980;3:121–3. 15 Gibson G. Measures of emergency ambulance effectiveness: unmet need and inappropriate use. J Am Coll Emerg Physicians 1977;6:389–92. 16 Audit Commission. A life in the fast lane: value for money in emergency ambulance services. London: Belmont Press, 1998. 17 Cooke MW, Morrell R, Wilson S, et al. Does criteria-based dispatch of 999 calls adequately detect the critically ill and injured? Prehospital Immediate Care 1999;3:191–5. 18 Lattimer V, George S, Thompson F, et al. The South Wiltshire Out of Hours Project (SWOOP) Group). Safety and effectiveness of nurse telephone consultation in out of hours primary care: randomised controlled trial. BMJ 1998;317:1054–9. 19 Crouch R, Dale J, Patel A, et al. Ringing the changes: developing, piloting and evaluating a telephone advice system in accident and emergency department and general practice settings. London: King’s College School of Medicine and Dentistry: Department of General Practice and Primary Care, 1996.
URI:	http://wrap.warwick.ac.uk/id/eprint/4356

Data sourced from Thomson Reuters' Web of Knowledge

Request changes to a record

Actions (login required)

View Item