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

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.

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The appropriateness of low-acuity cases referred for emergency ambulance dispatch following ambulance service secondary telephone triage: A retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0221158 ◽

2019 ◽

Vol 14 (8) ◽

pp. e0221158

Author(s):

Kathryn Eastwood ◽

Amee Morgans ◽

Johannes Stoelwinder ◽

Karen Smith

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Ambulance Service ◽

Telephone Triage ◽

Ambulance Dispatch ◽

Emergency Ambulance

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

Australasian Journal of Paramedicine ◽

10.33151/ajp.17.782 ◽

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.

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ABCD Approach At The #7119 Center, Telephone Triage System in Tokyo, Japan; A Retrospective Cohort Study

10.21203/rs.3.rs-827504/v1 ◽

2021 ◽

Author(s):

Atsushi Sakurai ◽

Sachiko Ohta ◽

Jun Oda ◽

Takashi Muguruma ◽

Takeru Abe ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Fire Department ◽

Telephone Triage ◽

Triage System ◽

Exact Test ◽

Almost All

Abstract Background The algorithm and protocol of the #7119 telephone triage in Tokyo, Japan, had been originally established and consists of three steps. In this study, we investigated the outcome of patients treated with physiological abnormality (ABCD approach: A, airway; B, breathing; C, circulation, and D, dysfunction of central nervous system) in step 2 during the #7119 telephone triage and clarified the meaning of evaluation of this approach. Methods We retrospectively reviewed data from the Tokyo Fire Department from January 2016 to December 2017. Almost all the patients triaged using the ABCD approach were transferred to the hospital by ambulance and assigned severity by a physician. We divided patients into groups with combinations of 15 patterns including A, B, C, D, AB, AC, AD, BC, BD, CD, ABC, ABD, ACD, BCD, and ABCD. We compared the proportion of severe cases in each group using a Fisher's exact test, followed by residual analysis.. Results We analyzed 13,793 cases triaged using the ABCD approach. In this analysis, 31% of total cases were assessed as severe cases. Groupwise analysis showed that the proportion of severe cases was significantly higher in the AD, BC, CD, ABD, and ABCD groups, while it was significantly less in the C and AB groups than in the total cases. Conclusion At the #7119 telephone triage, we can pick up the severe cases by the ABCD approach. This may contribute to the prompt transportation of severe patients to hospitals by dispatching ambulance cars using the #7119 telephone triage methods.

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