Association between ambulance dispatch priority and patient condition

作者：Ball, Stephen J.^*; Williams, Teresa A.; Smith, Karen; Cameron, Peter; Fatovich, Daniel; O'Halloran, Kay L.; Hendrie, Delia; Whiteside, Austin; Inoue, Madoka; Brink, Deon; Langridge, Iain; Pereira, Gavin; Tohira, Hideo; Chinnery, Sean; Bray, Janet E.; Bailey, Paul; Finn, Judith

来源：Emergency Medicine Australasia, 2016, 28(6): 716-724.

DOI：10.1111/1742-6723.12656

• ambulance
• critically ill
• paramedic
• patient acuity
• triage

Objective: To compare chief complaints of the Medical Priority Dispatch System in terms of the match between dispatch priority and patient condition.
Methods: This was a retrospective whole-of-population study of emergency ambulance dispatch in Perth, Western Australia, 1 January 2014 to 30 June 2015. Dispatch priority was categorised as either Priority 1 (high priority), or Priority 2 or 3. Patient condition was categorised as time-critical for patient(s) transported as Priority 1 to hospital or who died (and resuscitation was attempted by paramedics); else, patient condition was categorised as less time-critical. The.2 statistic was used to compare chief complaints by false omission rate (percentage of Priority 2 or 3 dispatches that were time-critical) and positive predictive value (percentage of Priority 1 dispatches that were time-critical). We also reported sensitivity and specificity.
Results: There were 211 473 cases of dispatch. Of 99988 cases with Priority 2 or 3 dispatch, 467 (0.5%) were time-critical. Convulsions/seizures and breathing problems were highlighted as having more false negatives (timecritical despite Priority 2 or 3 dispatch) than expected from the overall false omission rate. Of 111 485 cases with Priority 1 dispatch, 6520 (5.8%) were time-critical. Our analysis highlighted chest pain, heart problems/automatic implanted cardiac defibrillator, unknown problem/collapse, and headache as having fewer true positives (time-critical and Priority 1 dispatch) than expected fromthe overall positive predictive value.
Conclusion: Scope for reducing under-triage and over-triage of ambulance dispatch varies between chief complaints of the Medical Priority Dispatch System. The highlighted chief complaints should be considered for future research into improving ambulance dispatch system performance.

• 出版日期2016-12
• 单位河北医科大学