Määttä T, Kuisma M, Väyrynen T, Nousila-Wiik M, Porthan K, Boyd J, Kuosmanen J, Räsänen P
Emergency Medical Service, Helsinki University Central Hospital, Helsinki, Finland.
Acta Anaesthesiol Scand. 2010 Jul;54(6):689-95. doi: 10.1111/j.1399-6576.2010.02243.x. Epub 2010 May 6.
Dispatching centres were fused into one of the 112 entity, which caused concerns regarding whether the medical calls could be processed effectively also in the new centre. We evaluated the effects of the reform on key performance criteria in medical calls.
This observational study in the Helsinki Dispatching Centre consisted of two periods: Period I 2 years before the reform and Period II 2 years after. The main outcome measures were answering and call processing times, accuracy of risk assessment and appropriate use of ambulances.
In Period I (n=574,276), 92.2% of all incoming phone calls were answered within 10 s and in Period II (n=758,022) 82.8% (P<0.0001). Time to dispatch a first responding fire unit increased from 98 to 113 s (P<0.0001) and an advanced life support unit in category A calls increased from 73 to 84 s (P<0.0001). In Period I 47.7%, 34.8% and 17.5% of phone calls were completed in <3, 3-5 and >5 min and in Period II 29.8%, 36.1% and 34.1% (P<0.0001). The number of three studied non-transportation call types and unnecessary lights-and-siren responses increased significantly (P<0.0001 and 0.0001, respectively). Neither the accuracy of risk assessment in the three studied call types nor the rate of telephone-guided cardiopulmonary resuscitation changed.
The reform increased the total number of ambulance dispatches, prolonged answering and call processing times and had a negative effect on the appropriate use of ambulances. The accuracy of risk assessment was not affected. Evidence-based data should be the basis for the future as dispatching centre processes are shown to be vulnerable during organisational reforms.
调度中心被整合到112系统中，这引发了人们对新中心能否有效处理医疗呼叫的担忧。我们评估了此次改革对医疗呼叫关键绩效标准的影响。
这项在赫尔辛基调度中心进行的观察性研究包括两个阶段：改革前2年的第一阶段和改革后2年的第二阶段。主要观察指标为接听和呼叫处理时间、风险评估的准确性以及救护车的合理使用情况。
在第一阶段（n = 574,276），92.2%的来电在10秒内得到接听，而在第二阶段（n = 758,022）这一比例为82.8%（P < 0.0001）。派遣第一支响应的消防单位的时间从98秒增加到113秒（P < 0.0001），A类呼叫中派遣高级生命支持单位的时间从73秒增加到84秒（P < 0.0001）。在第一阶段，47.7%、34.8%和17.5%的电话在<3分钟、3 - 5分钟和>5分钟内完成，而在第二阶段分别为29.8%、36.1%和34.1%（P < 0.0001）。三种研究的非运输类呼叫类型的数量以及不必要的警灯和警报响应显著增加（分别为P < 0.0001和0.0001）。三种研究呼叫类型的风险评估准确性以及电话指导心肺复苏的比例均未改变。
改革增加了救护车调度的总数，延长了接听和呼叫处理时间，并对救护车的合理使用产生了负面影响。风险评估的准确性未受影响。由于在组织改革期间调度中心流程显示出脆弱性，基于证据的数据应成为未来的基础。
