Using trigger tools to identify triage errors by ambulance dispatch nurses in Sweden: an observational study

Abstract

ObjectivesThis study aimed to assess whether trigger tools were useful identifying triage errors among patients referred to non-emergency care by emergency medical dispatch nurses, and to describe the characteristics of these patients.DesignAn observational study of patients referred by dispatch nurses to non-emergency care.SettingDispatch centres in two Swedish regions.ParticipantsA total of 1089 adult patients directed to non-emergency care by dispatch nurses between October 2016 and February 2017. 53% were female and the median age was 61 years.Primary and secondary outcome measuresThe primary outcome was a visit to an emergency department within 7 days of contact with the dispatch centre. Secondary outcomes were (1) visits related to the primary contact with the dispatch centre, (2) provision of care above the primary level (ie, interventions not available at a typical local primary care centre) and (3) admission to hospital in-patient care.ResultsOf 1089 included patients, 260 (24%) visited an emergency department within 7 days. Of these, 209 (80%) were related to the dispatch centre contact, 143 (55%) received interventions above the primary care level and 99 (38%) were admitted to in-patient care. Elderly (65+) patients (OR 1.45, 95% CI 1.05 to 1.98) and patients referred onwards to other healthcare providers (OR 1.58, 95% CI 1.15 to 2.19) had higher likelihoods of visiting an emergency department. Six avoidable patient harms were identified, none of which were captured by existing incident reporting systems, and all of which would have received an ambulance if the decision support system had been strictly adhered to.ConclusionThe use of these patient outcomes in the framework of a Global Trigger Tool-based review can identify patient harms missed by incident reporting systems in the context of emergency medical dispatching. Increased compliance with the decision support system has the potential to improve patient safety.

Prehospital identification of Covid-19: an observational study

“…The inclusion criteria for this study select for patients cared for through the typical prehospital care pathway of ambulance transport to the ED, and many patients referred to alternate forms of care by dispatchers and ambulance crews, as is common in the studied region [ 20 ], were not included owing to the lack of relevant outcome data for these patients. It may also be that some cases of Covid-19 were hospital-acquired, and that prehospital care providers could not have been expected to identify them.…”

Registered Nurses' experiences of using a clinical decision support system for triage of emergency calls: A qualitative interview study

“…This willingness to deviate from the CDSS indicates that RNs used their professional competence and autonomy, instead of being steered by the CDSS. While professional autonomy is desirable, previous studies have showed that triage errors in the context of EMDCs could have been avoided by greater compliance with CDSS (Andersen et al., 2014; Spangler et al., 2020). As such, optimal methods to gain the benefits of both professional autonomy and CDSS compliance should be identified through further research.…”

“…While CDSSs are intended to improve decision accuracy and patient safety, the professional autonomy of RNs could be limited by working through a rigid, mechanistic system. This tension could lead to RNs overruling the CDSS or using it only partially, which in turn might hamper patient safety (Spangler et al., 2020). Hence, more knowledge is needed of RNs views in these matters to enhance both technical development of CDSS and the work situation of RNs at EMDCs.…”

Significance of incident reports by medical doctors for organizational transparency and driving forces for patient safety

“…Although the incident reporting system does not reflect the actual hospital-wide events in our centre, it is a worthwhile source of information from which to discover potential risks and attributable factors of a representative patient safety issue [3,9]. In this system, events whose potential consequences are difficult to measure in patient prognosis and which have been caused by external events or inappropriate or defective internal processes, systems, and/or systemic improvement activity are also indicated as risks [10]. Accumulation of near-miss incidents of the same type and with a small impact as a one-off event also carries the risk of potential adverse events.…”