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Dispatcher Triage Accuracy in the Western Cape Government Emergency Medical Services System, Cape Town, South Africa

Published online by Cambridge University Press:  25 August 2020

Mohammed F. Alshehri ,
Jennifer L. Pigoga Open the ORCID record for Jennifer L. Pigoga [Opens in a new window]  and
Lee A. Wallis
Mohammed F. Alshehri
Affiliation:
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
Jennifer L. Pigoga*
Affiliation:
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
Lee A. Wallis
Affiliation:
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
*
Correspondence: Jennifer Pigoga University of Cape Town Anzio Road Observatory, Cape Town, 7935South Africa E-mail: [email protected]
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Abstract

Introduction:

Triage - the sorting of patients according to urgency of need for clinical care - is an essential part of delivering effective and efficient emergency care. But when frequent over- or under-triaging occurs, finite time and resources are diverted away from those in greatest need of care and the entire Emergency Medical Services (EMS) system is strained. In resource-constrained settings, such as South Africa, poor triage in EMS only serves to compound other contextual challenges. This study examined the accuracy of dispatcher triage over a one-year period in the Western Cape Government (WCG) EMS system in South Africa.

Methods:

A retrospective analysis of existing dispatch and EMS data to assess the accuracy of dispatch-assigned priorities was conducted. The mismatch between dispatcher-assigned call priority and triage levels determined by EMS personnel was analyzed via over- and under-triage rates, sensitivity and specificity, and positive and negative predictive values (PPVs and NPVs, respectively).

Results:

A total of 185,166 records from December 2016 through November 2017 were analyzed. Across all dispatch complaints, the over-triage rate was 67.6% (95% CI, 66.34-68.76) and the under-triage rate was 16.2% (95% CI, 15.44-16.90). Dispatch triage sensitivity for all included records was 49.2% (95% CI, 48.10-50.38), specificity 71.9% (95% CI, 71.00-72.92), PPV 32.5% (95% CI, 30.02-34.88), and NPV 83.8% (95% CI, 81.93-85.73).

Conclusion:

This study provides the first evaluation of dispatch triage accuracy in the WCG EMS system, identifying that the system is suffering from both under- and over-triage. Despite variance across dispatch complaints, both under- and over-triage remained higher than widely accepted norms, and all rates were significantly above acceptable target metrics described in similar studies. Results of this study will be used to motivate the development of more rigorous training programs and resources for WCG EMS dispatchers, including improved dispatch protocols for conditions suffering from high over- and under-triage.

Keywords

Emergency Medical Servicesemergency medicineprehospital caretriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 6 , December 2020 , pp. 638 - 644
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Merriam Webster. Definition of triage. https://www.merriam-webster.com/dictionary/triage. Accessed January 2020.Google Scholar
Hinson, JS, Martinez, DA, Schmitz, PSK, et al. Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis. Int J Emerg Med. 2018;11(1):3.CrossRefGoogle ScholarPubMed
Bandara, D, Mayorga, E, McLay, L. Priority dispatching strategies for EMS systems. J Oper Res Soc. 2014;65(4):572–587.CrossRefGoogle Scholar
Dami, F, Golay, C, Pasquier, M, et al. Prehospital triage accuracy in a criteria-based dispatch centre. BMC Emerg Med. 2015;15:32.CrossRefGoogle Scholar
Michailidou, M, Goldstein, SD, Salazar, J, et al. Helicopter over-triage in pediatric trauma. J Pediatr Surg. 2014;49(11):1673–1677.10.1016/j.jpedsurg.2014.08.008CrossRefGoogle Scholar
Western Cape Province, South Africa The Editors of Encyclopedia Britannica. https://www.britannica.com/place/Western-Cape. Accessed January 2020.Google Scholar
Naidoo, R. Emergency care in Africa. Afr J Emerg Med. 2011;1:51–52.CrossRefGoogle Scholar
Hardcastle, TC, Finlayson, M, van Heerden, M, et al. The prehospital burden of disease due to trauma in KwaZulu-Natal: the need for Afrocentric trauma systems. World J Surg. 2012;37(7):1513–1525.10.1007/s00268-012-1852-1CrossRefGoogle Scholar
Western Cape Government. Medical Emergency Transport and Rescue Cape Town: 2017. https://www.westerncape.gov.za/service/medical-emergency-transport-and-rescue-metro. Accessed August 23, 2017.Google Scholar
Cape Town: Western Cape Government: Health, 2016. Annual Report 2015/2016.Google Scholar
Clawson, J, Olola, CH, Heward, A, et al. Accuracy of emergency medical dispatchers’ subjective ability to identify when higher dispatch levels are warranted over a Medical Priority Dispatch System automated protocol’s recommended coding based on paramedic outcome data. Emerg Med J. 2007;24(8):560–563.CrossRefGoogle Scholar
Newton, P. An Evaluation of the Appropriateness of the Emergency Medical Service (EMS) Responses in the Ethekwini Health District of Kwazulu-Natal. Durban, South Africa: Durban University of Technology; 2014.Google Scholar
Clawson, J, Martin, RL, Hauert, SA. Protocols vs. Guidelines - Choosing a Medical-Dispatch Program. https://www.emergencydispatch.org/articles/protocolsvsguidelines1.htm. Accessed January 2020.Google Scholar
Bohm, K, Kurland, L. The accuracy of medical dispatch - a systematic review. Scand J Trauma Resusc Emerg Med. 2018;26(1):94.CrossRefGoogle ScholarPubMed
Alshehri, MF, Pigoga, JL, Wallis, LA. A mixed methods investigation of emergency communications centre triage in the Government Emergency Medical Services System, Cape Town, South Africa. Afr J Emerg Med. 2020. In press.10.1016/j.afjem.2020.02.004CrossRefGoogle Scholar
Gottschalk, SB, Wood, D, DeVries, S, et al. The Cape Triage Score: a new triage system South Africa. Proposal from the Cape Triage Group. Emerg Med J. 2006;23(2):149–153.CrossRefGoogle ScholarPubMed
Lentz, BA, Jenson, A, Hinson, JS, et al. Validity of ED: addressing heterogeneous definitions of over-triage and under-triage. Am J Emerg Med. 2017;35(7):1023–1025.CrossRefGoogle ScholarPubMed
Sasser, SM, Hunt, RC, Faul, M, et al. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012;61(RR-1):1–20.Google Scholar
Peng, J, Xiang, H. Trauma under-triage and over-triage rates: are we using the wrong formulas? Am J Emerg Med. 2016;34(11):2191–2192.CrossRefGoogle Scholar
Hosseini, SMR, Maleki, M, Gorji, HA, et al. Factors affecting emergency medical dispatchers’ decision-making: a qualitative study. J Multidiscip Healthc. 2018;11:391–98.CrossRefGoogle ScholarPubMed
Feldman, MJ, Verbeek, PR, Lyons, DG, et al. Comparison of the medical priority dispatch system to an out-of-hospital patient acuity score. Acad Emerg Med. 2006;13(9):954–960.10.1197/j.aem.2006.04.018CrossRefGoogle Scholar
Flynn, J, Archer, F, Morgans, A. Sensitivity and specificity of the medical priority dispatch system in detecting cardiac arrest emergency calls in Melbourne. Prehosp Disaster Med. 2006;21(2):72–76.CrossRefGoogle ScholarPubMed
Voskens, FJ, van Rein, EAJ, van der Sluijs, R, et al. Accuracy of prehospital triage in selecting severely injured trauma patients. JAMA Surg. 2018;153(4):322–327.CrossRefGoogle ScholarPubMed
Tanabe, P, Gimbel, R, Yarnold, PR, et al. Reliability and validity of scores on the Emergency Severity Index version 3. Acad Emerg Med. 2004;11(1):59–65.CrossRefGoogle ScholarPubMed
Wuerz, RC, Travers, D, Gilboy, N, et al. Implementation and refinement of the emergency severity index. Acad Emerg Med. 2001;8(2):170–176.CrossRefGoogle ScholarPubMed
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