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Accuracy of Nature of Call screening tool in identifying patients requiring treatment for out of hospital cardiac arrest

Accuracy of Nature of Call screening tool in identifying patients requiring treatment for out of hospital cardiac arrest
Accuracy of Nature of Call screening tool in identifying patients requiring treatment for out of hospital cardiac arrest
Background A new pre-triage screening tool, Nature of Call (NoC), has been introduced into the telephone triage system of UK ambulance services which employ National Health Service Pathways (NHSP). Its function is to provide rapid recognition of patients who may need immediate ambulance dispatch for out-of-hospital cardiac arrest (OHCA) and withholding dispatch for other calls while further triage is undertaken. In this study, we evaluated the accuracy of NoC and NHSP in identifying patients with potentially treatable or imminent OHCA.

Methods This retrospective, observational study reviewed consecutive calls to a UK ambulance service between October 2016 and February 2017 in which NOC, and then NHSP were applied sequentially. Only those calls for which a corresponding electronic Patient Clinical Record was available were included. Sensitivity and specificity of NOC and NHSP for recognition of an OHCA were determined by comparing allocated priority dispositions with an OHCA Treatment Registry (OHCATR).

Results Of 96 423 calls received, 71 373 were reviewed. For 590 (0.8%) of these calls, the patients received treatment for OHCA. NOC identified 458 OHCATR patients; NHSP identified 467; together they identified 496. NoC captured 29 patients not identified by NHSP; NHSP captured 38 patients not identified by NOC. For NOC sensitivity was 77.6% (95% CI 74.1 to 80.8) and specificity 86.9% (95% CI 86.6 to 87.1). NHSP sensitivity was 79.2% (95% CI 75.7 to 82.2) and specificity 93.4% (95% CI 93.2 to 93.6). NoC and NHSP combined had a sensitivity of 84.1% (95% CI 80.9 to 86.8) and specificity of 85.3% (95% CI 85.1 to 85.6).

Conclusions NoC and NHSP call categorisation each achieved similar sensitivity for the identification of OHCATR, identifying most of the same patients, but each captured unique patients. Using both methods sequentially improved accuracy. The 16% of OHCATR patients not identified by either method present a challenge to ambulance dispatch systems.
1472-0205
203-207
Green, Jonathan
e7c9a3f4-afdf-4be0-80cd-5d1608db0373
Ewings, Sean
326656df-c0f0-44a1-b64f-8fe9578ca18a
Wortham, Richard
85d64457-0f30-4ab0-9636-439036e333dc
Walsh, Bronagh
5818243e-048d-4b4b-88c5-231b0e419427
Green, Jonathan
e7c9a3f4-afdf-4be0-80cd-5d1608db0373
Ewings, Sean
326656df-c0f0-44a1-b64f-8fe9578ca18a
Wortham, Richard
85d64457-0f30-4ab0-9636-439036e333dc
Walsh, Bronagh
5818243e-048d-4b4b-88c5-231b0e419427

Green, Jonathan, Ewings, Sean, Wortham, Richard and Walsh, Bronagh (2019) Accuracy of Nature of Call screening tool in identifying patients requiring treatment for out of hospital cardiac arrest. Emergency Medicine Journal, 36 (4), 203-207. (doi:10.1136/emermed-2017-207354).

Record type: Article

Abstract

Background A new pre-triage screening tool, Nature of Call (NoC), has been introduced into the telephone triage system of UK ambulance services which employ National Health Service Pathways (NHSP). Its function is to provide rapid recognition of patients who may need immediate ambulance dispatch for out-of-hospital cardiac arrest (OHCA) and withholding dispatch for other calls while further triage is undertaken. In this study, we evaluated the accuracy of NoC and NHSP in identifying patients with potentially treatable or imminent OHCA.

Methods This retrospective, observational study reviewed consecutive calls to a UK ambulance service between October 2016 and February 2017 in which NOC, and then NHSP were applied sequentially. Only those calls for which a corresponding electronic Patient Clinical Record was available were included. Sensitivity and specificity of NOC and NHSP for recognition of an OHCA were determined by comparing allocated priority dispositions with an OHCA Treatment Registry (OHCATR).

Results Of 96 423 calls received, 71 373 were reviewed. For 590 (0.8%) of these calls, the patients received treatment for OHCA. NOC identified 458 OHCATR patients; NHSP identified 467; together they identified 496. NoC captured 29 patients not identified by NHSP; NHSP captured 38 patients not identified by NOC. For NOC sensitivity was 77.6% (95% CI 74.1 to 80.8) and specificity 86.9% (95% CI 86.6 to 87.1). NHSP sensitivity was 79.2% (95% CI 75.7 to 82.2) and specificity 93.4% (95% CI 93.2 to 93.6). NoC and NHSP combined had a sensitivity of 84.1% (95% CI 80.9 to 86.8) and specificity of 85.3% (95% CI 85.1 to 85.6).

Conclusions NoC and NHSP call categorisation each achieved similar sensitivity for the identification of OHCATR, identifying most of the same patients, but each captured unique patients. Using both methods sequentially improved accuracy. The 16% of OHCATR patients not identified by either method present a challenge to ambulance dispatch systems.

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Accepted/In Press date: 14 January 2019
e-pub ahead of print date: 6 February 2019
Published date: 6 February 2019

Identifiers

Local EPrints ID: 427940
URI: https://eprints.soton.ac.uk/id/eprint/427940
ISSN: 1472-0205
PURE UUID: 1397b499-64db-43e8-9665-c331b3d54d3d
ORCID for Sean Ewings: ORCID iD orcid.org/0000-0001-7214-4917
ORCID for Bronagh Walsh: ORCID iD orcid.org/0000-0003-1008-0545

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Date deposited: 05 Feb 2019 17:30
Last modified: 10 May 2019 00:36

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