scholarly journals A novel approach for managing the growing demand for ambulance services by low-acuity patients

2016 ◽  
Vol 40 (4) ◽  
pp. 378 ◽  
Author(s):  
Kathryn Eastwood ◽  
Amee Morgans ◽  
Karen Smith ◽  
Angela Hodgkinson ◽  
Gareth Becker ◽  
...  
Keyword(s):  
Emergency Services ◽  
Service Providers ◽  
Response Times ◽  
Telephone Triage ◽  
Skill Levels ◽  
Ambulance Dispatch ◽  
Novel Approach ◽  
Emergency Ambulance ◽  
Using Data ◽  
Australian Bureau Of Statistics

Objective The aim of the present study was to describe the Ambulance Victoria (AV) secondary telephone triage service, called the Referral Service (RS), for low-priority patients calling triple zero. This service provides alternatives to ambulance dispatch, such as doctor or nurse home visits. Methods A descriptive epidemiological review of all the cases managed between 2009 and 2012 was conducted, using data from AV case records, the Victorian Admitted Episodes Dataset and the Australian Bureau of Statistics. Cases were reviewed for patient demographics, condition, final disposition and RS outcome. Results In all, 107148 cases were included in the study, accounting for 10.3% of the total calls for ambulance attendance. Median patient age was 54 years and 55% were female. Geographically based socioeconomic status was associated with the rate of calls to the RS (r = –0.72; 95% confidence interval CI –0.104, –0.049; P < 0.001). Abdominal pain and back symptoms were the most common patient problems. Although 68% of patients were referred to the emergency department, only 27.6% of the total cases were by emergency ambulance; the remainder were diverted to non-emergency ambulance or the patient’s own private transport. The remaining 32% of cases were referred to alternative service providers or given home care advice. Conclusions This paper describes the use of an ongoing secondary triage service, providing an effective strategy for managing emergency ambulance demand. What is known about the topic? Some calls to emergency services telephone numbers for ambulance assistance consist of cases deemed to be low-acuity that could potentially be better managed in the primary care setting. The demand on ambulance resources is increasing each year. Secondary telephone triage systems have been trialled in ambulance services in the US and UK with minimal success in terms of overall impact on ambulance resourcing. What does this paper add? This study describes a model of secondary telephone triage in the ambulance setting that has provided an effective way to divert patients to more suitable forms of health care to meet their needs. What are the implications for practitioners? The implications for practitioners are vast. Some of the issues that currently face paramedics include: fatigue because of high workloads; skills decay because of a lack of exposure to patients requiring intervention with skills the paramedics have, as well as a lack of time for paramedics to practice these skills during their downtime; and decreasing job satisfaction linked to both these factors. Implications for patients include quicker response times because more ambulances will be available to respond and increased patient safety because of decreased fatigue and higher skill levels in paramedics.

scholarly journals Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e042351
Author(s):  
Kathryn Eastwood ◽  
Dhanya Nambiar ◽  
Rosamond Dwyer ◽  
Judy A Lowthian ◽  
Peter Cameron ◽  
...  
Keyword(s):  
Cohort Study ◽  
Older Adult ◽  
Retrospective Cohort Study ◽  
Older Patients ◽  
Retrospective Cohort ◽  
Vital Signs ◽  
Telephone Triage ◽  
Ambulance Dispatch ◽  
Emergency Ambulance ◽  
Primary Triage

BackgroundMost calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches.ObjectivesTo examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch.DesignA retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted.SettingThe secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period.ParticipantsThere were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses.Main outcome measuresDescriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients.ResultsThe dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005).ConclusionSecondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.

scholarly journals What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Helen A. Snooks ◽  
Ashrafunnesa Khanom ◽  
Robert Cole ◽  
Adrian Edwards ◽  
Bethan Mair Edwards ◽  
...  
Keyword(s):  
Case Management ◽  
National Survey ◽  
Current Practice ◽  
Emergency Services ◽  
Response Times ◽  
Models Of Care ◽  
Call Centre ◽  
Complex Needs ◽  
Team Meetings ◽  
Emergency Ambulance

Abstract Background Emergency ambulance services are integral to providing a service for those with unplanned urgent and life-threatening health conditions. However, high use of the service by a small minority of patients is a concern. Our objectives were to describe: service-wide and local policies or pathways for people classified as Frequent Caller; call volume; and results of any audit or evaluation. Method We conducted a national survey of current practice in ambulance services in relation to the management of people who call the emergency ambulance service frequently using a structured questionnaire for completion by email and telephone interview. We analysed responses using a descriptive and thematic approach. Results Twelve of 13 UK ambulance services responded. Most services used nationally agreed definitions for ‘Frequent Caller’, with 600–900 people meeting this classification each month. Service-wide policies were in place, with local variations. Models of care varied from within-service care where calls are flagged in the call centre; contact made with callers; and their General Practitioner (GP) with an aim of discouraging further calls, to case management through cross-service, multi-disciplinary team meetings aiming to resolve callers’ needs. Although data were available related to volume of calls and number of callers meeting the threshold for definition as Frequent Caller, no formal audits or evaluations were reported. Conclusions Ambulance services are under pressure to meet challenging response times for high acuity patients. Tensions are apparent in the provision of care to patients who have complex needs and call frequently. Multi-disciplinary case management approaches may help to provide appropriate care, and reduce demand on emergency services. However, there is currently inadequate evidence to inform commissioning, policy or practice development.

scholarly journals Pre-hospital emergency care system: Utilization of ambulance services in Nairobi county

2021 ◽  
Vol 17 (4) ◽  
Author(s):  
Felistus Ndanu Musyoka ◽  
Abdushakur Ndolo Kioko
Keyword(s):  
Emergency Care ◽  
Emergency Services ◽  
Service Providers ◽  
Public Awareness ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
Hospital Environment ◽  
Hospital Emergency ◽  
Cross Sectional ◽  
Ambulance Dispatch

Emergency Medical Service (EMS) is the system that organizes all aspects of medical care provided to patients in the pre-hospital environment and emergency department within hospitals. It comprises agencies and organizations (both private and public), communication and transportation networks, hospitals, highly trained professionals and a public aware on how to respond in emergencies. Kenya needs robust EMS due to the high prevalence of acute medical events such as COVID-19, natural and man-made disasters. The objective of this study was to assess utilization of ambulance services in Nairobi County. The study design was descriptive cross-sectional, using quantitative and qualitative research methods. Data was collected using interviewer-administered semi-structured questionnaires and key in-depth interviews from 14 ambulance services, 19 Emergency Care Centers (ECC), and community. Thirty-nine key informants were sampled using purposive sampling technique and 101 community members sampled using simple random sampling technique from 10 sub-counties. Data tools were pretested at Mukuru Kwa Njenga, a populous slum in Nairobi County. Approval to carry out the study was granted by the Ministry of Health, Kenya. Qualitative data was analyzed using NVIVO12 and quantitative data analyzed using descriptive statistics by use of SPSS vs 25 software. Findings are represented as frequencies and percentages. There were 14 ambulance service providers in the Nairobi Metropolitan Services area with a total of 42 ambulances. Forty-one ambulances were facility-based ambulances. All ambulance services had emergency numbers, and only 3 had short-toll free ambulance access numbers. There were 9 different ambulance dispatch centers in the county. Five ambulance services did not have a dispatch Centre. Public members were the first to assist in in 79% emergencies. There was low public awareness on available pre-hospital emergency care services and tollfree lines for emergency services. Ambulances utilization was also low.

scholarly journals Characteristics associated with emergency department suitability in low-acuity ambulance cases

2020 ◽  
Vol 17 ◽  
Author(s):  
Kathryn Eastwood ◽  
Amee Morgans ◽  
Karen Smith
Keyword(s):  
Emergency Department ◽  
Cohort Analysis ◽  
Binary Logistic Regression ◽  
Time Of Day ◽  
Binary Logistic Regression Analysis ◽  
Telephone Triage ◽  
Income Status ◽  
Ambulance Dispatch ◽  
Emergency Ambulance ◽  
Case Characteristics

ObjectiveTo identify the patient and case characteristics associated with emergency department (ED) suitability of cases referred for emergency ambulance dispatch following ambulance-based secondary telephone triage. MethodsA retrospective cohort analysis was conducted of secondary telephone triage cases transported to an ED by emergency ambulance between September 2009 and June 2012 in Melbourne, Australia. Patients were considered ED suitable if they were triaged as a category 1, 2 or 3 according to the Australian Triage Scale, were admitted to hospital or referred to another hospital for admission, or died in the ED.Descriptive statistics and multivariable binary logistic regression analysis were used to identify the variables associated with ED suitability. ResultsThere were 2694 (21.2%) cases classified as ‘not ED suitable’. The mean age of this group was 51.7 years (SD 23.7 years) and 56.5% were female. Those that were ED suitable were older, with a mean age of 59.1 years (SD 22.6 years) and 53.6% were female. After adjusting for confounders the age (p<0.001), pain (p<0.001) and triage guideline groups (p<0.001) variables had statistically significant relationships with ED suitability. Gender (p=0.108), time of day (p=0.118), secondary triage call-taker qualification (p=0.237) and comorbidities (p=0.182) showed no association with ED suitability, and income status was approaching significance (95% CI 0.85–1.02, p=0.055). ConclusionThere are patient and case characteristics associated with ED suitability that could be used to improve patient triage to better match patients with care pathways appropriate to their needs.

scholarly journals Novel approach to modeling high-frequency activity data to assess therapeutic effects of analgesics in chronic pain conditions

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zekun Xu ◽  
Eric Laber ◽  
Ana-Maria Staicu ◽  
B. Duncan X. Lascelles
Keyword(s):  
High Frequency ◽  
Activity Patterns ◽  
Treatment Strategies ◽  
Therapeutic Effects ◽  
Activity Levels ◽  
Activity Data ◽  
Novel Approach ◽  
High Frequency Activity ◽  
Using Data ◽  
Chronic Pain Conditions

AbstractOsteoarthritis (OA) is a chronic condition often associated with pain, affecting approximately fourteen percent of the population, and increasing in prevalence. A globally aging population have made treating OA-associated pain as well as maintaining mobility and activity a public health priority. OA affects all mammals, and the use of spontaneous animal models is one promising approach for improving translational pain research and the development of effective treatment strategies. Accelerometers are a common tool for collecting high-frequency activity data on animals to study the effects of treatment on pain related activity patterns. There has recently been increasing interest in their use to understand treatment effects in human pain conditions. However, activity patterns vary widely across subjects; furthermore, the effects of treatment may manifest in higher or lower activity counts or in subtler ways like changes in the frequency of certain types of activities. We use a zero inflated Poisson hidden semi-Markov model to characterize activity patterns and subsequently derive estimators of the treatment effect in terms of changes in activity levels or frequency of activity type. We demonstrate the application of our model, and its advance over traditional analysis methods, using data from a naturally occurring feline OA-associated pain model.

scholarly journals Estimating PQoS of Video Conferencing on Wi-Fi Networks Using Machine Learning

2021 ◽  
Vol 13 (3) ◽  
pp. 63
Author(s):  
Maghsoud Morshedi ◽  
Josef Noll
Keyword(s):  
Machine Learning ◽  
Network Performance ◽  
Service Providers ◽  
Video Conferencing ◽  
Machine Learning Algorithms ◽  
Performance Parameters ◽  
High Definition ◽  
Internet Service ◽  
Novel Approach ◽  
5 Ghz

Video conferencing services based on web real-time communication (WebRTC) protocol are growing in popularity among Internet users as multi-platform solutions enabling interactive communication from anywhere, especially during this pandemic era. Meanwhile, Internet service providers (ISPs) have deployed fiber links and customer premises equipment that operate according to recent 802.11ac/ax standards and promise users the ability to establish uninterrupted video conferencing calls with ultra-high-definition video and audio quality. However, the best-effort nature of 802.11 networks and the high variability of wireless medium conditions hinder users experiencing uninterrupted high-quality video conferencing. This paper presents a novel approach to estimate the perceived quality of service (PQoS) of video conferencing using only 802.11-specific network performance parameters collected from Wi-Fi access points (APs) on customer premises. This study produced datasets comprising 802.11-specific network performance parameters collected from off-the-shelf Wi-Fi APs operating at 802.11g/n/ac/ax standards on both 2.4 and 5 GHz frequency bands to train machine learning algorithms. In this way, we achieved classification accuracies of 92–98% in estimating the level of PQoS of video conferencing services on various Wi-Fi networks. To efficiently troubleshoot wireless issues, we further analyzed the machine learning model to correlate features in the model with the root cause of quality degradation. Thus, ISPs can utilize the approach presented in this study to provide predictable and measurable wireless quality by implementing a non-intrusive quality monitoring approach in the form of edge computing that preserves customers’ privacy while reducing the operational costs of monitoring and data analytics.

scholarly journals Knowledge discovery from emergency ambulance dispatch during COVID-19: A case study of Nagoya City, Japan

2021 ◽  
pp. 103743
Author(s):  
Essam A. Rashed ◽  
Sachiko Kodera ◽  
Hidenobu Shirakami ◽  
Ryotetsu Kawaguchi ◽  
Kazuhiro Watanabe ◽  
...  
Keyword(s):  
Knowledge Discovery ◽  
Ambulance Dispatch ◽  
Emergency Ambulance

scholarly journals Modelling improved efficiency in healthcare referral systems for the urban poor using a geo-referenced health facility data: the case of Sylhet City Corporation, Bangladesh

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Alayne M. Adams ◽  
Rushdia Ahmed ◽  
Shakil Ahmed ◽  
Sifat Shahana Yusuf ◽  
Rubana Islam ◽  
...  
Keyword(s):  
Critical Care ◽  
Urban Poor ◽  
Emergency Services ◽  
Census Data ◽  
Service Providers ◽  
Healthcare Services ◽  
Tertiary Hospital ◽  
Care Services ◽  
Referral Systems ◽  
Alternative Scenarios

Abstract Background An effective referral system is critical to ensuring access to appropriate and timely healthcare services. In pluralistic healthcare systems such as Bangladesh, referral inefficiencies due to distance, diversion to inappropriate facilities and unsuitable hours of service are common, particularly for the urban poor. This study explores the reported referral networks of urban facilities and models alternative scenarios that increase referral efficiency in terms of distance and service hours. Methods Road network and geo-referenced facility census data from Sylhet City Corporation were used to examine referral linkages between public, private and NGO facilities for maternal and emergency/critical care services, respectively. Geographic distances were calculated using ArcGIS Network Analyst extension through a “distance matrix” which was imported into a relational database. For each reported referral linkage, an alternative referral destination was identified that provided the same service at a closer distance as indicated by facility geo-location and distance analysis. Independent sample t-tests with unequal variances were performed to analyze differences in distance for each alternate scenario modelled. Results The large majority of reported referrals were received by public facilities. Taking into account distance, cost and hours of service, alternative scenarios for emergency services can augment referral efficiencies by 1.5–1.9 km (p < 0.05) compared to 2.5–2.7 km in the current scenario. For maternal health services, modeled alternate referrals enabled greater referral efficiency if directed to private and NGO-managed facilities, while still ensuring availability after working-hours. These referral alternatives also decreased the burden on Sylhet City’s major public tertiary hospital, where most referrals were directed. Nevertheless, associated costs may be disadvantageous for the urban poor. Conclusions For both maternal and emergency/critical care services, significant distance reductions can be achieved for public, NGO and private facilities that avert burden on Sylhet City’s largest public tertiary hospital. GIS-informed analyses can help strengthen coordination between service providers and contribute to more effective and equitable referral systems in Bangladesh and similar countries.

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