Emergency Department, Hôpital Neuchâtelois, Maladière 45, 2000, Neuchâtel, Switzerland.
Dispatch Centre, State of Vaud (Fondation Urgences-Santé), César-Roux 31, 1005, Lausanne, Switzerland.
Scand J Trauma Resusc Emerg Med. 2017 Apr 13;25(1):40. doi: 10.1186/s13049-017-0383-z.
Dispatch centres (DCs) are considered an essential but expensive component of many highly developed healthcare systems. The number of DCs in a country, region, or state is usually based on local history and often related to highly decentralised healthcare systems. Today, current technology (Global Positioning System or Internet access) abolishes the need for closeness between DCs and the population. Switzerland went from 22 DCs in 2006 to 17 today. This study describes from a quality and patient safety point of view the merger of two DCs.
The study analysed the performance (over and under-triage) of two medical DCs for 12 months prior to merging and for 12 months again after the merger in 2015. Performance was measured comparing the priority level chosen by dispatcher and the severity of cases assessed by paramedics on site using the National Advisory Committee for Aeronautics (NACA) score. We ruled that NACA score > 3 (injuries/diseases which can possibly lead to deterioration of vital signs) to 7 (lethal injuries/diseases) should require a priority dispatch with lights and siren (L&S). While NACA score < 4 should require a priority dispatch without L&S. Over-triage was defined as the proportion of L&S dispatches with a NACA score < 4, and under-triage as the proportion of dispatches without L&S with a NACA > 3.
Prior to merging, Dispatch A had a sensitivity/specificity regarding the use of lights and sirens and severity of cases of 86%/48% with over- and under-triage rates of 78% and 5%, respectively. Dispatch B had sensitivity and specificity of 92%/20% and over- and under-triage rates of 84% and 7%, respectively. After they merged, global sensitivity/specificity reached 87%/67%, and over- and under-triage rates were 71% and 3%, respectively CONCLUSIONS: A part the potential cost advantage achieved by the merger of two DCs, it can improve the quality of services to the population, reducing over- and under-triage and the use of lights and sirens and therefore, the risk of accidents. This is especially the case when a DC with poor triage performance merges with a high-performing DC.
调度中心（DC）被认为是许多高度发达的医疗保健系统的重要但昂贵的组成部分。一个国家、地区或州的调度中心数量通常基于当地历史，并且通常与高度分散的医疗保健系统有关。如今，当前技术（全球定位系统或互联网接入）消除了 DC 与人群之间的紧密联系的需求。瑞士的调度中心数量从 2006 年的 22 个减少到了今天的 17 个。本研究从质量和患者安全的角度描述了两个调度中心的合并。
该研究分析了在 2015 年合并之前的 12 个月和合并之后的 12 个月中两个医疗调度中心的表现（分诊过度和不足）。通过比较调度员选择的优先级级别和现场护理人员使用国家航空咨询委员会（NACA）评分评估的病例严重程度，来衡量性能。我们规定 NACA 评分>3（可能导致生命体征恶化的伤害/疾病）至 7（致命伤害/疾病）的病例应需要灯光和警笛（L&S）的优先调度。而 NACA 评分<4 的病例应需要无 L&S 的优先调度。分诊过度被定义为 NACA 评分<4 的 L&S 调度比例，分诊不足被定义为无 L&S 的调度比例 NACA>3。
在合并之前，调度 A 使用灯光和警笛以及病例严重程度的敏感性/特异性分别为 86%/48%，过度和不足分诊的比例分别为 78%和 5%。调度 B 的敏感性和特异性分别为 92%/20%，过度和不足分诊的比例分别为 84%和 7%。合并后，整体敏感性/特异性达到 87%/67%，过度和不足分诊的比例分别为 71%和 3%。
除了合并两个调度中心实现的潜在成本优势外，还可以提高向人群提供服务的质量，减少过度和不足分诊以及灯光和警笛的使用，从而降低事故风险。当分诊性能较差的调度中心与性能较高的调度中心合并时，尤其如此。
