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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2018

Open Access 01-12-2018 | Original research

Patient and case characteristics associated with ‘no paramedic treatment’ for low-acuity cases referred for emergency ambulance dispatch following a secondary telephone triage: a retrospective cohort study

Authors: Kathryn Eastwood, Amee Morgans, Johannes Stoelwinder, Karen Smith

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2018

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Abstract

Background

Predicting case types that are unlikely to be treated by paramedics can aid in managing demand for emergency ambulances by identifying cases suitable for alternative management pathways. The aim of this study was to identify the patient characteristics and triage outcomes associated with ‘no paramedic treatment’ for cases referred for emergency ambulance dispatch following secondary telephone triage.

Methods

A retrospective cohort analysis was conducted of cases referred for emergency ambulance dispatch following secondary telephone triage between September 2009 and June 2012. Multivariable logistic regression modelling was used to identify explanatory variables associated with ‘no paramedic treatment’.

Results

There were 19,041 cases eligible for inclusion in this study over almost three years, of which 8510 (44.7%) were not treated after being sent an emergency ambulance following secondary triage. Age, time of day, pain, triage guideline group, and comorbidities were associated with ‘no paramedic treatment’. In particular, cases 0–4 years of age or those with psychiatric conditions were significantly less likely to be treated by paramedics, and increasing pain resulted in higher rates of paramedic treatment.

Conclusions

This study highlights that case characteristics can be used to identify particular case types that may benefit from care pathways other than emergency ambulance dispatch. This process is also useful to identify gaps in the alternative care pathways currently available. These findings offer the opportunity to optimise secondary telephone triage services to support their strategic purpose of minimising unnecessary emergency ambulance demand and to match the right case with the right care pathway.
Literature
1.
Uscher-Pines L, Pines J, Kellermann A, Gillen E, Mehrotra A. Deciding to visit the emergency Department for non-Urgent Conditions: a systematic review of the literature. Am J Manag Care. 2013;19(1):47–59.PubMedPubMedCentral
2.
Grusd E, Kramer-Johansen J. Does the Norwegian emergency medical dispatch classification as non-urgent predict no need for pre-hospital medical treatment? An observational study. Scand J Trauma Resusc Emerg Med. 2016;24(1):65.CrossRefPubMedPubMedCentral
3.
Sporer KA, Craig AM, Johnson NJ, Yeh CC. Does emergency medical dispatch priority predict delphi process-derived levels of prehospital intervention? Prehospital Disaster Med. 2010;25(4):309–17.CrossRefPubMed
4.
Sporer KA, Johnson NJ, Yeh CC, Youngblood GM. Can emergency medical dispatch codes predict prehospital interventions for common 9-1-1 call types? Prehosp Emerg Care. 2008;12(4):470–8.CrossRefPubMed
5.
Sporer KA, Wilson KG. How well do emergency medical dispatch codes predict prehospital medication administration in a diverse urban community? J Emerg Med. 2013;44(2):413–22. e3CrossRefPubMed
6.
Sporer KA, Youngblood GM, Rodriguez RM. The ability of emergency medical dispatch codes of medical complaints to predict ALS prehospital interventions. Prehosp Emerg Care. 2007;11(2):192–8.CrossRefPubMed
7.
Shah MN, Bishop P, Lerner EB, Czapranski T, Davis EA. Derivation of emergency medical services dispatch codes associated with low-acuity patients. Prehosp Emerg Care. 2003;7(4):434–9.CrossRefPubMed
8.
Shah MN, Bishop P, Lerner EB, Fairbanks RJ, Davis EA. Validation of using EMS dispatch codes to identify low-acuity patients. Prehosp Emerg Care. 2005;9(1):24–31.CrossRefPubMed
9.
Craig A, Schwartz B, Feldman M. Development of evidence-based dispatch plans to optimize ALS paramedic response in an urban EMS system [abstract]. Prehosp Emerg Care. 2006;10:114.
10.
Hinchey P, Myers B, Zalkin J, Lewis R, Garner D. Low acuity EMS dispatch criteria can reliably identify patients without high-acuity illness or injury. Prehosp Emerg Care. 2007;11(1):42–8.CrossRefPubMed
11.
Evans R, McGovern R, Birch J, Newbury-Birch D. Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literature. Emerg Med J. 2014;31(7):594–603.CrossRefPubMed
12.
Durant E, Fahimi J. Factors associated with ambulance use among patients with low-acuity conditions. Prehosp Emerg Care. 2012;16(3):329–37.CrossRefPubMed
13.
Dale J, Higgins J, Williams S, Foster T, Snooks H, Crouch R, et al. Computer assisted assessment and advice for “non-serious” 999 ambulance service callers: the potential impact on ambulance despatch. Emerg Med J. 2003;20(2):178–83.CrossRefPubMedPubMedCentral
14.
Snooks H, Williams S, Crouch R, Foster T, Hartley-Sharpe C, Dale J. NHS emergency response to 999 calls: alternatives for cases that are neither life threatening nor serious. [review] [29 refs]. BMJ. 2002;325(7359):330–3.CrossRefPubMedPubMedCentral
15.
Eastwood K, Morgans A, Smith K, Hodgkinson A, Becker G, Stoelwinder J. A novel approach for managing the growing demand for ambulance services by low-acuity patients. Australian Health Review: A Publication Of The Australian Hospital Association. 2015.
16.
Dale J, Williams S, Foster T, Higgins J, Snooks H, Crouch R, et al. Safety of telephone consultation for “non-serious” emergency ambulance service patients. Qual Safety Health Care. 2004;13(5):363–73.CrossRef
17.
Studnek J, Thestrup L, Blackwell T, Bagwell B. Utilization of prehospital dispatch protocols to identify low-acuity patients. Prehosp Emerg Care. 2012;16(2):204–9.CrossRefPubMed
18.
Smith WR, Culley L, Plorde M, Murray JA, Hearne T, Goldberg P, et al. Emergency medical services telephone referral program: an alternative approach to nonurgent 911 calls. Prehosp Emerg Care. 2001;5(2):174–80.CrossRefPubMed
19.
Crowther L, Williams R. Nurse interventions in ambulance command-and-control centres. Emerg Nurse. 2009;17:22–5.CrossRefPubMed
20.
Turner J, Snooks H, Youren A, Dixon S, Fall D, Gaze S, et al. The costs and benefits of managing some low priority 999 ambulance calls by NHS Direct nurse advisers. Sheffield: The University of Sheffield; 2006.
21.
Fox C, Rodriguez C, McSwain NE. EMT telephone triage. EMT J. 1981;5(6):410–5.PubMed
22.
Fivaz MC, McQueen J, Barron T, Clawson J, Scott G, Gardett MI, et al. The distribution of recommended care levels by age, gender, and trauma vs medical classification within the emergency communication nurse system. Ann Emerg Dispatch Response. 2015;3(1):14–20.
23.
Eastwood K, Morgans A, Smith K, Stoelwinder J. Secondary triage in prehospital emergency ambulance services: a systematic review. Emerg Med J. 2014;32(6):486–92.CrossRefPubMed
24.
Lowthian JA, Cameron PA, Stoelwinder JU, Curtis A, Currell A, Cooke MW, et al. Increasing utilisation of emergency ambulances. Aust Health Rev. 2011;35(1):63–9. 7pCrossRefPubMed
25.
26.
27.
28.
Eastwood K, Smith K, Morgans A, Stoelwinder J. Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study. BMJ Open. 2017;7(10):e016845.
29.
Ambulance Victoria. Ambulance Victoria Annual Report 2011–2012. Doncaster: Ambulance Victoria; 2012.
30.
Ambulance Victoria. Delivering our patients the right care, at the right time, at the right place: revised clinical response model evaluation report. Doncaster; 2017.
31.
Murad H, Fleischman A, Sadetzki S, Geyer O, Freedman LS. Small samples and ordered logistic regression: does it help to collapse categories of outcome? Am Stat. 2003;57(3):155–60.CrossRef
32.
Lund B, Raimi S. Collapsing levels of predictor variables for logistic rgression and weight of evidence coding. MidWest SAS Users Group 2012; 2012 September 16–18; Minneapolis, MN. Minneapolis, MN2012.
33.
Tabachnick B, Fidell L. Using multivariate statistics. Boston: Pearson; 2001.
34.
IMB Corp. IBM SPSS statistics for windows. 23.0 ed. IBM Corp: Armonk, NY; 2015.
35.
Suruda A, Vernon DD, Reading J, Cook L, Nechodom P, Leonard D, et al. Pre-hospital emergency medical services: a population based study of pediatric utilization. Inj Prev. 1999;5(4):294–7.CrossRefPubMedPubMedCentral
36.
Camasso-Richardson K, Wilde JA, Petrack EM. Medically unnecessary pediatric ambulance transports: a medical taxi service? Acad Emerg Med. 1997;4(12):1137–41.CrossRefPubMed
37.
Fessler SJ, Simon HK, Yancey Ii AH, Colman M, Hirsh DA. How well do general EMS 911 dispatch protocols predict ED resource utilization for pediatric patients? Am J Emerg Med. 2014;32(3):199–202.CrossRefPubMed
38.
Spooren D, Buylaert W, Jannes C, Henderick H, Van Heeringen C. Patients with psychiatric emergencies transported by an ambulance in an urban region. European journal of emergency medicine: official journal of the European society for. Emerg Med. 1996;3(1):14.
39.
Vine R. Safe transport of people with a mental illness. In: health do, editor. Mental health, drugs and regions division, Victorian Government: Melbourne; 2011.
40.
Branch MH. Protocol for the transport of people with mental illness 2014. In: Health Do, editor. . Melbourne: Department of Health. p. 2014.
41.
Cone DC, Schmidt TA, Mann NC, Brown L. Developing research criteria to define medical necessity in emergency medical services. Prehosp Emerg Care. 2004;8(2):116–25.PubMed
Metadata
Title
Patient and case characteristics associated with ‘no paramedic treatment’ for low-acuity cases referred for emergency ambulance dispatch following a secondary telephone triage: a retrospective cohort study
Authors
Kathryn Eastwood
Amee Morgans
Johannes Stoelwinder
Karen Smith
Publication date
01-12-2018
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-018-0475-4

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