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A comparison of two emergency medical dispatch protocols with respect to accuracy

Torlén, Klara; Kurland, Lisa; Castrén, Maaret; Olanders, Knut LU and Bohm, Katarina (2017) In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 25(1).
Abstract

Background: Emergency medical dispatching should be as accurate as possible in order to ensure patient safety and optimize the use of ambulance resources. This study aimed to compare the accuracy, measured as priority level, between two Swedish dispatch protocols - the three-graded priority protocol Medical Index and a newly developed prototype, the four-graded priority protocol, RETTS-A. Methods: A simulation study was carried out at the Emergency Medical Communication Centre (EMCC) in Stockholm, Sweden, between October and March 2016. Fifty-three voluntary telecommunicators working at SOS Alarm were recruited nationally. Each telecommunicator handled 26 emergency medical calls, simulated by experienced standard patients. Manuscripts... (More)

Background: Emergency medical dispatching should be as accurate as possible in order to ensure patient safety and optimize the use of ambulance resources. This study aimed to compare the accuracy, measured as priority level, between two Swedish dispatch protocols - the three-graded priority protocol Medical Index and a newly developed prototype, the four-graded priority protocol, RETTS-A. Methods: A simulation study was carried out at the Emergency Medical Communication Centre (EMCC) in Stockholm, Sweden, between October and March 2016. Fifty-three voluntary telecommunicators working at SOS Alarm were recruited nationally. Each telecommunicator handled 26 emergency medical calls, simulated by experienced standard patients. Manuscripts for the scenarios were based on recorded real-life calls, representing the six most common complaints. A cross-over design with 13+13 calls was used. Priority level and medical condition for each scenario was set through expert consensus and used as gold standard in the study. Results: A total of 1293 calls were included in the analysis. For priority level, n=349 (54.0%) of the calls were assessed correctly with Medical Index and n=309 (48.0%) with RETTS-A (p=0.012). Sensitivity for the highest priority level was 82.6% (95% confidence interval: 76.6-87.3%) in the Medical Index and 54.0% (44.3-63.4%) in RETTS-A. Overtriage was 37.9% (34.2-41.7%) in the Medical Index and 28.6% (25.2-32.2%) in RETTS-A. The corresponding proportion of undertriage was 6.3% (4.7-8.5%) and 23.4% (20.3-26.9%) respectively. Conclusion: In this simulation study we demonstrate that Medical Index had a higher accuracy for priority level and less undertriage than the new prototype RETTS-A. The overall accuracy of both protocols is to be considered as low. Overtriage challenges resource utilization while undertriage threatens patient safety. The results suggest that in order to improve patient safety both protocols need revisions in order to guarantee safe emergency medical dispatching.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Dispatch protocol, Emergency medical dispatch, Emergency medical services, Medical order entry systems, Patient safety
in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
volume
25
issue
1
publisher
BioMed Central
external identifiers
  • scopus:85039706271
ISSN
1757-7241
DOI
10.1186/s13049-017-0464-z
language
English
LU publication?
yes
id
540a0065-8524-4855-9976-bf684e323688
date added to LUP
2018-01-22 12:35:49
date last changed
2018-05-29 09:24:06
@article{540a0065-8524-4855-9976-bf684e323688,
  abstract     = {<p>Background: Emergency medical dispatching should be as accurate as possible in order to ensure patient safety and optimize the use of ambulance resources. This study aimed to compare the accuracy, measured as priority level, between two Swedish dispatch protocols - the three-graded priority protocol Medical Index and a newly developed prototype, the four-graded priority protocol, RETTS-A. Methods: A simulation study was carried out at the Emergency Medical Communication Centre (EMCC) in Stockholm, Sweden, between October and March 2016. Fifty-three voluntary telecommunicators working at SOS Alarm were recruited nationally. Each telecommunicator handled 26 emergency medical calls, simulated by experienced standard patients. Manuscripts for the scenarios were based on recorded real-life calls, representing the six most common complaints. A cross-over design with 13+13 calls was used. Priority level and medical condition for each scenario was set through expert consensus and used as gold standard in the study. Results: A total of 1293 calls were included in the analysis. For priority level, n=349 (54.0%) of the calls were assessed correctly with Medical Index and n=309 (48.0%) with RETTS-A (p=0.012). Sensitivity for the highest priority level was 82.6% (95% confidence interval: 76.6-87.3%) in the Medical Index and 54.0% (44.3-63.4%) in RETTS-A. Overtriage was 37.9% (34.2-41.7%) in the Medical Index and 28.6% (25.2-32.2%) in RETTS-A. The corresponding proportion of undertriage was 6.3% (4.7-8.5%) and 23.4% (20.3-26.9%) respectively. Conclusion: In this simulation study we demonstrate that Medical Index had a higher accuracy for priority level and less undertriage than the new prototype RETTS-A. The overall accuracy of both protocols is to be considered as low. Overtriage challenges resource utilization while undertriage threatens patient safety. The results suggest that in order to improve patient safety both protocols need revisions in order to guarantee safe emergency medical dispatching.</p>},
  articleno    = {122},
  author       = {Torlén, Klara and Kurland, Lisa and Castrén, Maaret and Olanders, Knut and Bohm, Katarina},
  issn         = {1757-7241},
  keyword      = {Dispatch protocol,Emergency medical dispatch,Emergency medical services,Medical order entry systems,Patient safety},
  language     = {eng},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine},
  title        = {A comparison of two emergency medical dispatch protocols with respect to accuracy},
  url          = {http://dx.doi.org/10.1186/s13049-017-0464-z},
  volume       = {25},
  year         = {2017},
}