Stephen J Ball1, Teresa A Williams1, Karen Smith2,3,4, Peter Cameron2, Daniel Fatovich4,5,6, Kay L O'Halloran7, Delia Hendrie8, Austin Whiteside9, Madoka Inoue1, Deon Brink9, Iain Langridge9, Gavin Pereira8, Hideo Tohira1, Sean Chinnery9, Janet E Bray1,2, Paul Bailey9,10, Judith Finn1,2,4. 1. Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia. 2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 3. Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia. 4. Discipline of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia. 5. Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia. 6. Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia. 7. School of Education, Curtin University, Perth, Western Australia, Australia. 8. School of Public Health, Curtin University, Perth, Western Australia, Australia. 9. St John Ambulance (WA), Perth, Western Australia, Australia. 10. Emergency Medicine, St John of God Hospital Murdoch, Perth, Western Australia, Australia.
Abstract
OBJECTIVE: To compare chief complaints of the Medical Priority Dispatch System in terms of the match between dispatch priority and patient condition. METHODS: This was a retrospective whole-of-population study of emergency ambulance dispatch in Perth, Western Australia, 1 January 2014 to 30 June 2015. Dispatch priority was categorised as either Priority 1 (high priority), or Priority 2 or 3. Patient condition was categorised as time-critical for patient(s) transported as Priority 1 to hospital or who died (and resuscitation was attempted by paramedics); else, patient condition was categorised as less time-critical. The χ2 statistic was used to compare chief complaints by false omission rate (percentage of Priority 2 or 3 dispatches that were time-critical) and positive predictive value (percentage of Priority 1 dispatches that were time-critical). We also reported sensitivity and specificity. RESULTS: There were 211 473 cases of dispatch. Of 99 988 cases with Priority 2 or 3 dispatch, 467 (0.5%) were time-critical. Convulsions/seizures and breathing problems were highlighted as having more false negatives (time-critical despite Priority 2 or 3 dispatch) than expected from the overall false omission rate. Of 111 485 cases with Priority 1 dispatch, 6520 (5.8%) were time-critical. Our analysis highlighted chest pain, heart problems/automatic implanted cardiac defibrillator, unknown problem/collapse, and headache as having fewer true positives (time-critical and Priority 1 dispatch) than expected from the overall positive predictive value. CONCLUSION: Scope for reducing under-triage and over-triage of ambulance dispatch varies between chief complaints of the Medical Priority Dispatch System. The highlighted chief complaints should be considered for future research into improving ambulance dispatch system performance.
OBJECTIVE: To compare chief complaints of the Medical Priority Dispatch System in terms of the match between dispatch priority and patient condition. METHODS: This was a retrospective whole-of-population study of emergency ambulance dispatch in Perth, Western Australia, 1 January 2014 to 30 June 2015. Dispatch priority was categorised as either Priority 1 (high priority), or Priority 2 or 3. Patient condition was categorised as time-critical for patient(s) transported as Priority 1 to hospital or who died (and resuscitation was attempted by paramedics); else, patient condition was categorised as less time-critical. The χ2 statistic was used to compare chief complaints by false omission rate (percentage of Priority 2 or 3 dispatches that were time-critical) and positive predictive value (percentage of Priority 1 dispatches that were time-critical). We also reported sensitivity and specificity. RESULTS: There were 211 473 cases of dispatch. Of 99 988 cases with Priority 2 or 3 dispatch, 467 (0.5%) were time-critical. Convulsions/seizures and breathing problems were highlighted as having more false negatives (time-critical despite Priority 2 or 3 dispatch) than expected from the overall false omission rate. Of 111 485 cases with Priority 1 dispatch, 6520 (5.8%) were time-critical. Our analysis highlighted chest pain, heart problems/automatic implanted cardiac defibrillator, unknown problem/collapse, and headache as having fewer true positives (time-critical and Priority 1 dispatch) than expected from the overall positive predictive value. CONCLUSION: Scope for reducing under-triage and over-triage of ambulance dispatch varies between chief complaints of the Medical Priority Dispatch System. The highlighted chief complaints should be considered for future research into improving ambulance dispatch system performance.
Authors: Robert Larribau; Victor Nathan Chappuis; Philippe Cottet; Simon Regard; Hélène Deham; Florent Guiche; François Pierre Sarasin; Marc Niquille Journal: Int J Environ Res Public Health Date: 2020-11-09 Impact factor: 3.390
Authors: Victor Nathan Chappuis; Hélène Deham; Philippe Cottet; Birgit Andrea Gartner; François Pierre Sarasin; Marc Niquille; Laurent Suppan; Robert Larribau Journal: Scand J Trauma Resusc Emerg Med Date: 2021-02-09 Impact factor: 2.953