Merger of two dispatch centres: does it improve quality and patient safety?

Moser, Alfred; Mettler, Annette; Fuchs, Vincent; Hanhart, Walter; Robert, Claude-François; Santa, Vincent Della; Dami, Fabrice

doi:10.1186/s13049-017-0383-z

Cited by 8 publications

(12 citation statements)

References 24 publications

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“… Retrospective Very low Jämtland, Sweden Consecutive cases of medical dispatch 4835 ambulance dispatches Criteria Based Dispatch METTS-A according to ambulance was reference Leopardi M. and Sommacampagna M (2013) [ 30 ]. Retrospective observational Very low Italy Emergency calls 53,606 emergency calls “Regional system” The sensitivity of subjective experience-based nurse dispatch in detecting the need for phycisian interventions Moser A. et al (2017) [ 14 ]. Before/after comparison Very low Switzerland Emergency calls and connected ambulance records 27,886 (before) and 38,748(after) Criteria Based Dispatch Severity of cases assessed by paramedics on site using the NACA-score was used as reference CA Cardiac arrest, CPSS Cincinnati Prehospital Stroke Score, DPCI Dispatch Priority Card Index, HEMS Helicopter Emergency Medical Service, INT Paramedic interrogation of caller, MOI Mechanism of injury, NHS National Health System, REQ Land ambulance request …”

Section: Resultsmentioning

confidence: 99%

“…The overall sensitivity of identifying time critical conditions defined as ambulance dispatch priority 1 was 93.32% [ 28 ], for dispatching priority 1 and 2 in accordance with the standard of Medical Emergency Triage and Treatment System-A, METTS-A, red, orange and yellow, 95.9% [ 29 ]. In two studies, using Advisory Committee for Aeronautics (NACA) score, the overall sensitivity was 87% [ 14 ], and 86% [ 12 ] respectively. The sensitivity was 78.0% [ 30 ] using local criteria.…”

Section: Resultsmentioning

confidence: 99%

“…The sensitivity was 78.0% [ 30 ] using local criteria. While the specificity was 48% [ 13 ], 48.67% [ 29 ], 67% [ 14 ], 83.8%, and [ 30 ]. Ek et al showed a specificity of 15.4% for priority 3 dispatching in accordance with METTS-A green and blue [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

“…Ball et al reported PPV of 5.85% (CI 5.71–5.99%) and NPV of 0.47% (95% CI 0.43–0.51%) [ 28 ]. Over-triage rate was 78% [ 13 ] and 71% [ 14 ] and under-triage rate was 4.6% [ 13 ] and 3% [ 14 ] respectively.…”

Section: Resultsmentioning

confidence: 99%

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The accuracy of medical dispatch - a systematic review

Bohm

Kurland

2018

Scand J Trauma Resusc Emerg Med

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BackgroundIt is a challenge to dispatch Emergency medical Services (EMS) appropriately with limited resources and maintaining patient safety; this requires accurate dispatching systems. The objective of the current systematic review was to examine the evidence, according to GRADE, for medical dispatching systems to accurately dispatch EMS according to level of acuity and in recognition of specific conditions.A systematic search was performed trough PubMed, Web of Science, Embase (free text in all fields), Centre for Reviews and Dissemination (CRD), and Cochrane Central Register of Controlled Trials up to 16th of May, 2017. A combination of keywords and Medical Subject Heading (MeSH) terms relevant to “emergency medical dispatch criteria” were used, to search for articles published between 2012 and 2017. Publications were included according to the inclusion/exclusion criteria using the Systematic Reviews and Meta-Analyses (PRISMA) protocol. Level of evidence was evaluated in accordance with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Articles included were those that provided evidence for at least one of the measures of dispatch system accuracy; i.e. sensitivity, specificity, positive and negative predictive and/or over- and under-triage. The search identified 1445 articles. After the removal of duplicates, 382 titles were reviewed for relevance and an additional 359 articles were excluded based on manuscript title and abstract. An additional five articles were excluded after review of the full text versions of the remaining articles. The current review included 18 publications which all were based on primary research.ConclusionsThe 18 articles addressed the identification of cardiac arrest, stroke, medical priority and major trauma using different dispatching systems. The results of the current review show that there is a very low to low overall level of evidence for the accuracy of medical dispatching systems. We suggest that it is necessary to create a consensus on common standards for reporting before consensus can be reached for the level of accuracy in medical dispatching systems.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

The accuracy of medical dispatch - a systematic review

Bohm

Kurland

2018

Scand J Trauma Resusc Emerg Med

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“…As emergency medical dispatch systems tend to be inefficient, EMCCs frequently apply the rule, "when in doubt, send an ambulance with L&S", to ensure patient safety, which in turn leads to a high rate of over-triage [11,12,19]. The over-triage rate (100%−positive predictive value in percent) was measured at 71% in CBD systems [12,20], and 80%-94% in MPD [10,11], when the prevalence of a severe patient condition in the field was similar.…”

Section: Introductionmentioning

confidence: 99%

Symptom-Based Dispatching in an Emergency Medical Communication Centre: Sensitivity, Specificity, and the Area under the ROC Curve

Larribau

Chappuis

Cottet

et al. 2020

IJERPH

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Background: Measuring the performance of emergency medical dispatch tools used in paramedic-staffed emergency medical communication centres (EMCCs) is rarely performed. The objectives of our study were, therefore, to measure the performance and accuracy of Geneva’s dispatch system based on symptom assessment, in particular, the performance of ambulance dispatching with lights and sirens (L&S) and to measure the effect of adding specific protocols for each symptom. Methods: We performed a prospective observational study including all emergency calls received at Geneva’s EMCC (Switzerland) from 1 January 2014 to 1 July 2019. The risk levels selected during the emergency calls were compared to a reference standard, based on the National Advisory Committee for Aeronautics (NACA) scale, dichotomized to severe patient condition (NACA ≥ 4) or stable patient condition (NACA < 4) in the field. The symptom-based dispatch performance was assessed using a receiver operating characteristic (ROC) curve. Contingency tables and a Fagan nomogram were used to measure the performance of the dispatch with or without L&S. Measurements were carried out by symptom, and a group of symptoms with specific protocols was compared to a group without specific protocols. Results: We found an acceptable area under the ROC curve of 0.7474, 95%CI (0.7448–0.7503) for the 148,979 assessments included in the study. Where the severity prevalence was 21%, 95%CI (20.8–21.2). The sensitivity of the L&S dispatch was 87.5%, 95%CI (87.1–87.8); and the specificity was 47.3%, 95%CI (47.0–47.6). When symptom-specific assessment protocols were used, the accuracy of the assessments was slightly improved. Conclusions: Performance measurement of Geneva’s symptom-based dispatch system using standard diagnostic test performance measurement tools was possible. The performance was found to be comparable to other emergency medical dispatch systems using the same reference standard. However, the implementation of specific assessment protocols for each symptom may improve the accuracy of symptom-based dispatch systems.

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Mobile Medical Teams are Often Over-Qualified

Van Biesen,

Devue,

Van Laere

et al. 2023

Prehosp. Disaster med.

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Background and Importance: Emergency department (ED) staff in Belgium is simultaneously involved in patient care in the ED and in prehospital interventions as part of a Mobile Medical Team (MMT) or a Paramedic Intervention Team (PIT). There is a growing concern that the MMT is often over-qualified for the prehospital interventions they are dispatched to, while their absence from the ED results in insufficient human resources there. Objective: The current study aims to investigate whether this perception is correct in the EDs of two different regions, while also examining the differences between a two-tiered (2T) and a three-tiered (3T) Emergency Medical Services (EMS) region. Methods: A specially developed and pre-tested registration form was completed by physicians and nurses before and after each MMT intervention. The form included information on the composition of the MMT, the perceived need for MMT intervention pre-departure from the ED, the subjective appreciation of the need for the MMT after an intervention, and the therapeutic intervention(s) performed, in order to obtain a more objective appreciation of the actual need for an MMT. Data from a 2T and a 3T region were analyzed to rate the appropriateness of the interventions. Results: Although the 2T and 3T regions showed differences regarding MMT composition, dispatching, and logistics, the outcome of the study was identical in both regions. Before the intervention, physicians and nurses estimated that the MMT intervention would not be necessary in 37.7% of cases. However, following the intervention, it was subjectively deemed unnecessary in 65.7% of cases. Based on therapeutic interventions performed, the MMT was viewed as being over-qualified for carrying these out in 85.6% of cases. Post-intervention, the initial prediction that the MMT was over-qualified for the call was confirmed by the same physicians and nurses in 87.6% of cases, whilst their prediction was correct in 92.8% of cases in terms of the intervention that was carried out. Conclusion: In two different Belgian regions, the MMT is over-qualified in a vast majority of interventions. Physicians and nurses within the MMT can generally already predict that the MMT is over-qualified when leaving the ED. These findings suggest that there may be significant opportunities to improve the efficacy of human resources in the ED once there are less interventions carried out by an over-qualified MMT.

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Merger of two dispatch centres: does it improve quality and patient safety?

Cited by 8 publications

References 24 publications

The accuracy of medical dispatch - a systematic review

The accuracy of medical dispatch - a systematic review

Symptom-Based Dispatching in an Emergency Medical Communication Centre: Sensitivity, Specificity, and the Area under the ROC Curve

Mobile Medical Teams are Often Over-Qualified

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