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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, UtahUSA
Jeff Clawson
Affiliation:
Research and Standards Division, International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
Mark C. Fivaz
Affiliation:
Administration, Priority Solutions Inc., Salt Lake City, UtahUSA
Jennie McQueen
Affiliation:
Administration, Priority Solutions Inc., Salt Lake City, UtahUSA
Marie I. Gardett
Affiliation:
Research and Standards Division, International Academies of Emergency Dispatch, Salt Lake City, UtahUSA National MS Society-Utah Southern Idaho Chapter, Salt Lake City, UtahUSA
Bryon Schultz
Affiliation:
Emergency Medical Services Authority, Tulsa, OklahomaUSA
Scott Youngquist
Affiliation:
Salt Lake City Fire Department, Salt Lake City, UtahUSA
Christopher H.O. Olola
Affiliation:
Research and Standards Division, International Academies of Emergency Dispatch, Salt Lake City, UtahUSA
*
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: greg.scott@emergencydispatch.org
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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 

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