Dale J, Williams S, Foster T, Higgins J, Snooks H, Crouch R, Hartley-Sharpe C, Glucksman E, George S
Centre for Primary Health Care Studies, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
Qual Saf Health Care. 2004 Oct;13(5):363-73. doi: 10.1136/qhc.13.5.363.
To assess the safety of nurses and paramedics offering telephone assessment, triage, and advice as an alternative to immediate ambulance dispatch for emergency ambulance service callers classified by lay call takers as presenting with "non-serious" problems (category C calls).
Data for this study were collected as part of a pragmatic randomised controlled trial reported elsewhere. The intervention arm of the trial comprised nurse or paramedic telephone consultation using a computerised decision support system to assess, triage, and advise patients whose calls to the emergency ambulance service had been classified as "non-serious" by call takers applying standard priority dispatch criteria. A multidisciplinary expert clinical panel reviewed data from ambulance service, accident and emergency department, hospital inpatient and general practice records, and call transcripts for patients triaged by nurses and paramedics into categories that indicated that dispatch of an emergency ambulance was unnecessary. All cases for which one or more members of the panel rated that an emergency ambulance should have been dispatched were re-reviewed by the entire panel for an assessment of the "life risk" that might have resulted.
Ambulance services in London and the West Midlands, UK.
Of 635 category C patients assessed by nurses and paramedics, 330 (52%) cases that had been triaged as not requiring an emergency ambulance were identified.
Assessment of safety of triage decisions.
Sufficient data were available from the routine clinical records of 239 (72%) subjects to allow review by the specialist panel. For 231 (96.7%) sets of case notes reviewed, the majority of the panel concurred with the nurses' or paramedics' triage decision. Following secondary review of the records of the remaining eight patients, only two were rated by the majority as having required an emergency ambulance within 14 minutes. For neither of these did a majority of the panel consider that the patient would have been at "life risk" without an emergency ambulance being immediately dispatched. However, the transcripts of these two calls indicated that the correct triage decision had been communicated to the patient, which suggests that the triage decision had been incorrectly entered into the decision support system.
Telephone advice may be a safe method of managing many category C callers to 999 ambulance services. A clinical trial of the full implementation of this intervention is needed, large enough to exclude the possibility of rare adverse events.
评估护士和护理人员提供电话评估、分诊及建议作为一种替代方案的安全性，该替代方案针对被外行人分类为呈现“非严重”问题（C类呼叫）的紧急救护车服务呼叫者，替代立即派遣救护车。
本研究的数据收集作为其他地方报道的一项实用随机对照试验的一部分。该试验的干预组包括护士或护理人员使用计算机化决策支持系统进行电话咨询，以评估、分诊并为那些呼叫紧急救护车服务且接听者根据标准优先调度标准将其分类为“非严重”的患者提供建议。一个多学科专家临床小组审查了来自救护车服务、急诊科、医院住院部和全科医疗记录的数据，以及护士和护理人员分诊到表明无需派遣紧急救护车类别的患者的通话记录。对于小组中一个或多个成员认为应该派遣紧急救护车的所有病例，整个小组会重新审查，以评估可能导致的“生命风险”。
英国伦敦和西米德兰兹郡的救护车服务部门。
在护士和护理人员评估的635名C类患者中，确定了330例（52%）被分诊为不需要紧急救护车的病例。
评估分诊决策的安全性。
从239名（72%）受试者的常规临床记录中获得了足够的数据，可供专家小组审查。在审查的231组病例记录中（96.7%），小组中的大多数人同意护士或护理人员的分诊决策。在对其余8名患者的记录进行二次审查后，大多数人仅将其中2人评为在14分钟内需要紧急救护车。对于这两人，小组中的大多数人都不认为如果不立即派遣紧急救护车，患者会处于“生命危险”。然而，这两个电话的记录表明已将正确的分诊决策告知了患者，这表明分诊决策在决策支持系统中输入错误。
电话咨询可能是管理许多拨打999救护车服务的C类呼叫者的一种安全方法。需要对该干预措施的全面实施进行一项临床试验，规模要足够大，以排除罕见不良事件的可能性。
