The appropriateness of low-acuity cases referred for emergency ambulance dispatch following ambulance service secondary telephone triage: A retrospective cohort study

Abstract

Objective Ambulance-based secondary telephone triage systems have been established in ambulance services to divert low-acuity cases away from emergency ambulance dispatch. However, some low-acuity cases still receive an emergency ambulance dispatch following secondary triage. To date, no evidence exists identifying whether these cases required an emergency ambulance. The aim of this study was to investigate whether cases were appropriately referred for emergency ambulance dispatch following secondary telephone triage. Methods A retrospective cohort analysis was conducted of cases referred for emergency ambulance dispatch in Melbourne, Australia following secondary telephone triage between September 2009 and June 2012. Appropriateness was measured by assessing the frequency of advanced life support (ALS) treatment by paramedics, and paramedic transport to hospital. Results There were 23,696 cases included in this study. Overall, 54% of cases received paramedic treatment, which was similar to the state-wide rate for emergency ambulance cases (55.5%). All secondary telephone triage cases referred for emergency ambulance dispatch had transportation rates higher than all metropolitan emergency ambulance cases (82.2% versus 71.1%). Two-thirds of the cases that were transported were also treated by paramedics (66.5%), and 17.7% of cases were not transported to hospital by ambulance following paramedic assessment. Conclusions Overall, the cases returned for emergency ambulance dispatch following secondary telephone triage were appropriate. Nevertheless, the paramedic treatment rates in particular indicate a considerable rate of overtriage requiring further investigation to optimize the efficacy of secondary telephone triage.

<p>Relationship Between Nonconveyed Cases and On-Scene Time Intervals for Emergency Medical Services</p>

“…14 This study's result is lower than that found for the London metropolitan area, where 38%, were not in need of emergency assistance and not conveyed. 8 However, it was higher than that reported by Eastwood et al, 13 where 17.7% of cases were not conveyed by ambulance emergency and were inappropriate. Furthermore, our results showed a high percentage (71.86%) of patient/relative-initiated decisions for all nonconveyed cases.…”

“…8 A recent report indicated that 17.7% of cases were not conveyed by ambulance. 13 Moreover, Breeman et al reported that nearly 26.2% of ambulance runs resulted in nonconveyance. 14 Phillips et al described reasons for nonconveyance of probable patients.…”

Telephone Triage for Emergency Patients Reduces Unnecessary Ambulance Use: A Propensity Score Analysis With Population-Based Data in Osaka City, Japan

“…In Japan, anyone can call 1-1-9 for free access to an ambulance. In other countries such as Australia, the telephone triage service is used to triage the call and then transfer it to the ambulance dispatch center ( 8 , 10 ). To make telephone triage service more effective, it may be necessary not only to educate the public but also to change the social system for calling for an ambulance.…”

“…Eastwood et al revealed that planned emergency department (ED) visits were more likely to be ED suitable than unplanned ED visits (OR 1.62; 95%CI: 1.5–1.7) ( 8 ). Another study revealed that all secondary telephone triage cases referred for emergency ambulance dispatch had transportation rates higher than all metropolitan emergency ambulance cases (82.2% vs. 71.1%) ( 10 ). However, the effect of the telephone triage service on the EMS system has not been fully revealed.…”

Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study

“… 1 In 2018–2019, this secondary triage service diverted 15.6% (114 589 cases) of AV’s workload to alternative healthcare providers or home care, or following secondary triage, returned other cases for emergency ambulance dispatch (secondary dispatch). Research has shown that secondary dispatch cases had paramedic treatment rates similar to direct dispatch cases, 2 and were significantly more appropriate for the emergency department (ED). 3 Older adult patients are frequent users of ambulance services 4 ; however, little is known about their secondary triage usage and the appropriateness of the referral of these patients back into the emergency care pathways.…”