Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-14T13:20:12.916Z Has data issue: false hasContentIssue false
  • English
  • Français

Using On-scene EMS Responders’ Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers

Published online by Cambridge University Press:  13 January 2016

Greg Scott ,
Jeff Clawson ,
Mark C. Fivaz ,
Jennie McQueen ,
Marie I. Gardett ,
Bryon Schultz ,
Scott Youngquist  and
Christopher H.O. Olola
Greg Scott*
Affiliation:
Research and Standards Division, International Academies of Emergency Dispatch, Salt Lake City, Utah USA
Jeff Clawson
Affiliation:
Research and Standards Division, International Academies of Emergency Dispatch, Salt Lake City, Utah USA
Mark C. Fivaz
Affiliation:
Administration, Priority Solutions Inc., Salt Lake City, Utah USA
Jennie McQueen
Affiliation:
Administration, Priority Solutions Inc., Salt Lake City, Utah USA
Marie I. Gardett
Affiliation:
Research and Standards Division, International Academies of Emergency Dispatch, Salt Lake City, Utah USA National MS Society-Utah Southern Idaho Chapter, Salt Lake City, Utah USA
Bryon Schultz
Affiliation:
Emergency Medical Services Authority, Tulsa, Oklahoma USA
Scott Youngquist
Affiliation:
Salt Lake City Fire Department, Salt Lake City, Utah USA
Christopher H.O. Olola
Affiliation:
Research and Standards Division, International Academies of Emergency Dispatch, Salt Lake City, Utah USA
*
Correspondence: Greg Scott, MBA, EMD-QI International Academies of Emergency Dispatch (IAED) 110 S. Regent Street Suite 800 Salt Lake City, Utah 84111 USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Using the Medical Priority Dispatch System (MPDS) – a systematic 911 triage process – to identify a large subset of low-acuity patients for secondary nurse triage in the 911 center is a largely unstudied practice in North America. This study examines the ALPHA-level subset of low-acuity patients in the MPDS to determine the suitability of these patients for secondary triage by evaluating vital signs and necessity of lights-and-siren transport, as determined by attending Emergency Medical Services (EMS) ambulance crews.

Objectives

The primary objective of this study was to determine the clinical status of MPDS ALPHA-level (low-acuity) patients, as determined by on-scene EMS crews’ patient care records, in two US agencies. A secondary objective was to determine which ALPHA-level codes are suitable candidates for secondary triage by a trained Emergency Communication Nurse (ECN).

Methods

In this retrospective study, one full year (2013) of both dispatch data and EMS patient records data, associated with all calls coded at the ALPHA-level (low-acuity) in the dispatch protocol, were collected. The primary outcome measure was the number and percentage of ALPHA-level codes categorized as low-acuity, moderate-acuity, high-acuity, and critical using four common vital signs to assign these categories: systolic blood pressure (SBP), pulse rate (PR), oxygen saturation (SpO2), and Glasgow Coma Score (GCS). Vital sign data were obtained from ambulance crew electronic patient care records (ePCRs). The secondary endpoint was the number and percentage of ALPHA-level codes that received a “hot” (lights-and-siren) transport.

Results

Out of 19,300 cases, 16,763 (86.9%) were included in the final analysis, after excluding cases from health care providers and those with missing data. Of those, 89% of all cases did not have even one vital sign indicator of unstable patient status (high or critical vital sign). Of all cases, only 1.1% were transported lights-and-siren.

Conclusion

With the exception of the low-acuity, ALPHA-level seizure cases, the ALPHA-level patients are suitable to transfer for secondary triage in a best-practices, accredited, emergency medical dispatch center that utilizes the MPDS at very high compliance rates. The secondary nurse triage process should identify the few at-risk patients that exist in the low-acuity calls.

ScottG , ClawsonJ , FivazMC , McQueenJ , GardettMI , SchultzB , YoungquistS , OlolaCHO . Using On-scene EMS Responders’ Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers. Prehosp Disaster Med. 2016;31(1):46–57.

Keywords

dispatch priority levelselectronic patient care recordEMS communication systemslow-acuity callsMedical Priority Dispatch Systemsecondary nurse triage system
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 1 , February 2016 , pp. 46 - 57
Copyright
© World Association for Disaster and Emergency Medicine 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Clawson, JJ, Dernocoeur, K, Murray, C. Principles of Emergency Medical Dispatch Chapter 3: Structure and Function of Priority Dispatch; Understanding Determinant Terminology. 5th edition. Salt Lake City, Utah USA: Priority Press; 2014: 3.25.Google Scholar
2. Clawson, JJ, Dernocoeur, K, Murray, C. Principles of Emergency Medical Dispatch Chapter 12: Quality Management; Compliance Improves Determinant Correctness, Los Angeles City Fire Department Protocol Compliance Data. 5th edition. Salt Lake City, Utah USA: Priority Press; 2014: 12.08-12.10.Google Scholar
3. Clawson, JJ, Cady, G, Martin, R, Sinclair, R. The impact of a comprehensive quality management process on compliance to protocol in emergency medical dispatch center. Ann Emerg Med. 1998;32(5):578-584.Google Scholar
4. Shah, MN, Bishop, P, Lerner, B, Fairbanks, RJ, Davis, EA. Validation of using EMS dispatch codes to identify low-acuity patients. Prehosp Emerg Care. 2005;9(1):24-31.CrossRefGoogle ScholarPubMed
5. Hinchey, P, Myers, B, Zalkin, J, Lewis, R, Garner, D. Low-acuity EMS dispatch criteria can reliably identify patients without high-acuity illness or injury. Prehosp Emerg Care. 2007;11(1):42-48.Google Scholar
6. Kallsen, G. The use of priority medical dispatch to distinguish between high- and low-risk patients. Ann Emerg Med. 1990;19(4):29.Google Scholar
7. Stratton, S. Triage by Emergency Medical Dispatchers. Prehosp Disaster Med. 1992;7(3):263-269.CrossRefGoogle Scholar
8. Garza, AG, Gratton, MC, McElroy, J, Lindholm, D, Glass, E. The association of dispatch prioritization and patient acuity. Prehosp Emerg Care. 2008;12(1):24-29.CrossRefGoogle ScholarPubMed
9. Philip, KE, Pack, E, Cambiano, V, Rollmann, H, Weil, S, O’Bierne, J. The accuracy of respiratory rate assessment by doctors in a London teaching hospital: a cross-sectional study. J Clin Monit Comput. 2015;29(4):455-460.Google Scholar
10. Lovett, PB, Buchwald, JM, Sturmann, K, Bijur, P. The vexatious vital: neither clinical measurements by nurses nor an electronic monitor provides accurate measurements of respiratory rate in triage. Ann Emerg Med. 2005;45(1):68-76.Google Scholar
11. Nitzan, M, Romem, A, Koppel, R. Pulse oximetry: fundamentals and technology update. Med Devices (Auckl). 2014;7:231-239.Google ScholarPubMed
12. Kupas, D, Dula, D, Pino, J. Patient outcome using medical protocol to limit “lights and siren” transport. Prehosp Disaster Med. 1994;9(4):226-229.Google Scholar
13. Merlin, M, Baldino, K, Lehrfeld, D, et al. Use of a limited lights and siren protocol in the prehospital setting vs standard usage. Am J Emerg Med. 2012;30(4):519-525.Google Scholar
14. Barford, C, Lauritzen, MM, Danker, JK, et al. Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department – a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2012;20:28.Google Scholar
15. American College of Emergency Physicians; Clinical Policies Subcommittee on Seizures. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med. 2004;43(5):605-625.Google Scholar
16. Clawson, J. Various findings identified after an initial review of a 26-ALPHA-1 data set shared by an Accredited Center. International Academies of Emergency Dispatch. 2004; (Unpublished).Google Scholar
17. Krumholz, A, Wiebe, S, Gronseth, G, et al; Quality Standards Subcommittee of the American Academy of Neurology, American Epilepsy Society. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007;69(21):1996-2007.Google Scholar
18. Clawson, J. Various findings identified after an initial review of a 26-ALPHA-1 data set shared by an accredited center. International Academies of Emergency Dispatch. 2004;(Unpublished).Google Scholar
19. Fivaz, C, McQueen, J, Barron, T, et al. The distribution of recommended care levels by age, gender, and trauma vs medical classification within the Emergency Communication Nurse System. Annals of Emergency Dispatch and Response. 2015;3(1):14-20.Google Scholar