The University of Southampton
University of Southampton Institutional Repository

Safety of telephone consultation for “non-serious" emergency ambulance service patients

Safety of telephone consultation for “non-serious" emergency ambulance service patients
Safety of telephone consultation for “non-serious" emergency ambulance service patients
Objective: To assess the safety of nurses and paramedics offering telephone assessment, triage, and advice as an alternative to immediate ambulance despatch for emergency ambulance service callers classified by lay call takers as presenting with "non-serious" problems (category C calls).

Design: Data for this study were collected as part of a pragmatic randomised controlled trial reported elsewhere. The intervention arm of the trial comprised nurse or paramedic telephone consultation using a computerised decision support system to assess, triage, and advise patients whose calls to the emergency ambulance service had been classified as "non-serious" by call takers applying standard priority despatch criteria. A multidisciplinary expert clinical panel reviewed data from ambulance service, accident and emergency department, hospital inpatient and general practice records, and call transcripts for patients triaged by nurses and paramedics into categories that indicated that despatch of an emergency ambulance was unnecessary. All cases for which one or more members of the panel rated that an emergency ambulance should have been despatched were re-reviewed by the entire panel for an assessment of the "life risk" that might have resulted.

Setting: Ambulance services in London and the West Midlands, UK.

Study population: Of 635 category C patients assessed by nurses and paramedics, 330 (52%) cases that had been triaged as not requiring an emergency ambulance were identified.

Main outcome measures: Assessment of safety of triage decisions.

Results: Sufficient data were available from the routine clinical records of 239 (72%) subjects to allow review by the specialist panel. For 231 (96.7%) sets of case notes reviewed, the majority of the panel concurred with the nurses’ or paramedics’ triage decision. Following secondary review of the records of the remaining eight patients, only two were rated by the majority as having required an emergency ambulance within 14 minutes. For neither of these did a majority of the panel consider that the patient would have been at "life risk" without an emergency ambulance being immediately despatched. However, the transcripts of these two calls indicated that the correct triage decision had been communicated to the patient, which suggests that the triage decision had been incorrectly entered into the decision support system.

Conclusions: Telephone advice may be a safe method of managing many category C callers to 999 ambulance services. A clinical trial of the full implementation of this intervention is needed, large enough to exclude the possibility of rare adverse events.
telephone consultation, emergency ambulance service, patient safety, decision making, ambulance services
1475-3898
363-373
Dale, J.
36604f7b-015b-42b2-9f6a-3191b432ebc3
Williams, S.
762dd529-2acb-40b8-acf3-e3488eec8506
Foster, T.
f43d97d6-9e72-4a73-ad94-170f3b59c5cc
Higgins, J.
c0f7f60e-9dce-4761-8cc8-d88784829003
Snooks, H.
99b53f34-a43c-4085-aaad-bb9bbb3a0a7b
Crouch, R.
7f98a42e-ee34-4520-ab33-83cd3acf05b7
Hartley-Sharpe, C.
e78ae7f1-d589-4e7c-8d6c-2aace90398b2
Glucksman, E.
977e6d49-b3a5-4455-9a76-5622820a58d7
George, S.
bdfc752b-f67e-4490-8dc0-99bfaeb046ca
Dale, J.
36604f7b-015b-42b2-9f6a-3191b432ebc3
Williams, S.
762dd529-2acb-40b8-acf3-e3488eec8506
Foster, T.
f43d97d6-9e72-4a73-ad94-170f3b59c5cc
Higgins, J.
c0f7f60e-9dce-4761-8cc8-d88784829003
Snooks, H.
99b53f34-a43c-4085-aaad-bb9bbb3a0a7b
Crouch, R.
7f98a42e-ee34-4520-ab33-83cd3acf05b7
Hartley-Sharpe, C.
e78ae7f1-d589-4e7c-8d6c-2aace90398b2
Glucksman, E.
977e6d49-b3a5-4455-9a76-5622820a58d7
George, S.
bdfc752b-f67e-4490-8dc0-99bfaeb046ca

Dale, J., Williams, S., Foster, T., Higgins, J., Snooks, H., Crouch, R., Hartley-Sharpe, C., Glucksman, E. and George, S. (2004) Safety of telephone consultation for “non-serious" emergency ambulance service patients. Quality and Safety in Health Care, 13 (5), 363-373. (doi:10.1136/qshc.2003.008003).

Record type: Article

Abstract

Objective: To assess the safety of nurses and paramedics offering telephone assessment, triage, and advice as an alternative to immediate ambulance despatch for emergency ambulance service callers classified by lay call takers as presenting with "non-serious" problems (category C calls).

Design: Data for this study were collected as part of a pragmatic randomised controlled trial reported elsewhere. The intervention arm of the trial comprised nurse or paramedic telephone consultation using a computerised decision support system to assess, triage, and advise patients whose calls to the emergency ambulance service had been classified as "non-serious" by call takers applying standard priority despatch criteria. A multidisciplinary expert clinical panel reviewed data from ambulance service, accident and emergency department, hospital inpatient and general practice records, and call transcripts for patients triaged by nurses and paramedics into categories that indicated that despatch of an emergency ambulance was unnecessary. All cases for which one or more members of the panel rated that an emergency ambulance should have been despatched were re-reviewed by the entire panel for an assessment of the "life risk" that might have resulted.

Setting: Ambulance services in London and the West Midlands, UK.

Study population: Of 635 category C patients assessed by nurses and paramedics, 330 (52%) cases that had been triaged as not requiring an emergency ambulance were identified.

Main outcome measures: Assessment of safety of triage decisions.

Results: Sufficient data were available from the routine clinical records of 239 (72%) subjects to allow review by the specialist panel. For 231 (96.7%) sets of case notes reviewed, the majority of the panel concurred with the nurses’ or paramedics’ triage decision. Following secondary review of the records of the remaining eight patients, only two were rated by the majority as having required an emergency ambulance within 14 minutes. For neither of these did a majority of the panel consider that the patient would have been at "life risk" without an emergency ambulance being immediately despatched. However, the transcripts of these two calls indicated that the correct triage decision had been communicated to the patient, which suggests that the triage decision had been incorrectly entered into the decision support system.

Conclusions: Telephone advice may be a safe method of managing many category C callers to 999 ambulance services. A clinical trial of the full implementation of this intervention is needed, large enough to exclude the possibility of rare adverse events.

Text
66_QSHC_2004_13_363.pdf - Other
Restricted to Repository staff only
Request a copy

More information

Published date: October 2004
Keywords: telephone consultation, emergency ambulance service, patient safety, decision making, ambulance services

Identifiers

Local EPrints ID: 12558
URI: http://eprints.soton.ac.uk/id/eprint/12558
ISSN: 1475-3898
PURE UUID: 0b9e5ece-4a64-42d0-8ef2-350927e7ca9b

Catalogue record

Date deposited: 14 Dec 2004
Last modified: 15 Mar 2024 05:06

Export record

Altmetrics

Contributors

Author: J. Dale
Author: S. Williams
Author: T. Foster
Author: J. Higgins
Author: H. Snooks
Author: R. Crouch
Author: C. Hartley-Sharpe
Author: E. Glucksman
Author: S. George

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×