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Reliability of a Swedish pre-hospital dispatch system in prioritizing patients
Mid Sweden University, Östersund, Sweden.
County Hospital, Östersund, Sweden.
County Hospital, Östersund, Sweden.
Mid Sweden University, Östersund, Sweden.
2013 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 21, no 2, 143-149 p.Article in journal (Refereed) Published
Abstract [en]

The need of emergency help often begins with a call to a dispatch center. The operator uses a medical index to prioritize dispatches. Since the resources of ambulances are limited, it is important that the priority grading decided by the operator at the dispatch center is as adequate as possible. In the county of Jamtland in Sweden, a system for triage named METTS-A (Medical Emergency Triage and Treatment System-A) has been in use since 2009, when the patient is coded according to priority level. The aim of this study was to analyse the sensitivity and specificity of the priority grading made by the dispatch center in comparison with the METTS-A priority assessed by the ambulance nurse. Statistics from a data-base in northern Sweden were analyzed. The material covered every ambulance that was dispatched, 6986 times during the period of data collecting. The results show a high sensitivity but low specificity in the dispatch system. The results also indicate that over prioritization exists since most of the patients with a high acute need of an ambulance are correctly identified, while many patients without that need are also given a high priority ambulance service. Therefore the conclusions were that both over- and under prioritizations were made.

Place, publisher, year, edition, pages
Elsevier, 2013. Vol. 21, no 2, 143-149 p.
Keyword [en]
Ambulance calls, Emergency calls, Pre-hospital
National Category
Medical and Health Sciences Nursing
Identifiers
URN: urn:nbn:se:oru:diva-38265DOI: 10.1016/j.ienj.2011.11.006ISI: 000319032400011PubMedID: 23615523Scopus ID: 2-s2.0-84876789260OAI: oai:DiVA.org:oru-38265DiVA: diva2:759567
Available from: 2014-10-30 Created: 2014-10-30 Last updated: 2017-10-17Bibliographically approved
In thesis
1. Prioritering vid utlarmning i prehospital vård
Open this publication in new window or tab >>Prioritering vid utlarmning i prehospital vård
2014 (Swedish)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, emergency medical dispatch centres (EMD) cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Increased knowledge about the triage in the prehospital care can make it possible to optimize the use of resources. Traditionally nurses have an important role in triage on emergency departments and in telephone advisory. In Sweden there is a trend towards more triage by nurses at EMDs. It is important to survey experiences of nurses’ of prioritization at EMDs.

Aim: The overall aim in this thesis was to measure effectivity in prioritisation of ambulance dispatches, and to elucidate experiences from these prioritizations and decisions.

Method: In study I sensitivity and specificity in 4086 dispatches was calculated, by comparison of the priority given by the EMD and the assessment performed by the ambulance-nurse according to Medical Emergency Triage and Treatment System. In study II were 15 nurses interviewed about their experiences from prioritizations at an EMD.

Result: The result showed that 84,5 % of the dispatches were correct prioritised and that the sensitivity was high (94,5 %) but the specificity was low (15,4 %). Content analysis was performed and two themes emerged: “Having a profession with opportunities and obstacles” and “Meeting serious and difficult situations”. Conclusions are that over- prioritizations are made concerning patients with low or no need of medical care. Also that nurses with experience from emergency care, who are allowed to make their own decisions independent of the medical index, can improve and nuance the prioritization of resources in prehospital care. However, there is an obvious risk that their assessments will tend to be on the safe side. Important for avoiding this is improving internal support systems at the EMDs and also striving for a blame-free culture, where the nurses are not pushed by threats of being reported.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2014. 62 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063
Keyword
prioritization, experiences, triage, EMD, sensitivity, specificity, ambulance nurse, larmcentral, triage, ambulanssjukvård, innehållsanalys, sensitivitet, specificitet
National Category
Medical and Health Sciences
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-38272 (URN)
Presentation
2014-12-18, P247, Örebro, 14:10 (Swedish)
Opponent
Supervisors
Available from: 2015-03-20 Created: 2014-10-30 Last updated: 2017-10-17Bibliographically approved

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