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A comparison of two emergency medical dispatch protocols with respect to accuracy
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Department of Emergency Medicine, Örebro University Hospital, Örebro, Sweden.
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
Department of Anaesthesiology and ICU, Lund University Hospital, Lund, Sweden.
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2017 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 25, no 1, 122Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
London, United Kingdom: BioMed Central, 2017. Vol. 25, no 1, 122
Keyword [en]
Emergency medical dispatch, Emergency medical services, Dispatch protocol, Medical order entry systems, Patient safety
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:oru:diva-64008DOI: 10.1186/s13049-017-0464-zISI: 000419167200001PubMedID: 29284542Scopus ID: 2-s2.0-85039706271OAI: oai:DiVA.org:oru-64008DiVA: diva2:1173196
Available from: 2018-01-11 Created: 2018-01-11 Last updated: 2018-01-19Bibliographically approved

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