一项基于注册的观察性研究，比较了由紧急医疗调度员在有和没有注册护士支持的情况下评估的紧急呼叫。
A registry-based observational study comparing emergency calls assessed by emergency medical dispatchers with and without support by registered nurses.
机构信息
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 118 83, Stockholm, Sweden.
Department of Medical Sciences and Department of Emergency Medicine, Örebro University, 70181, Örebro, Sweden.
出版信息
Scand J Trauma Resusc Emerg Med. 2022 Jan 10;30(1):1. doi: 10.1186/s13049-021-00987-y.
BACKGROUND
The requirement concerning formal education for emergency medical dispatcher (EMD) is debated and varies, both nationally and internationally. There are few studies on the outcomes of emergency medical dispatching in relation to professional background. This study aimed to compare calls handled by an EMD with and without support by a registered nurse (RN), with respect to priority level, accuracy, and medical condition.
METHODS
A retrospective observational study, performed on registry data from specific regions during 2015. The ambulance personnel's first assessment of the priority level and medical condition was used as the reference standard. Outcomes were: the proportion of calls dispatched with a priority in concordance with the ambulance personnel's assessment; over- and undertriage; the proportion of most adverse over- and undertriage; sensitivity, specificity and predictive values for each of the ambulance priorities; proportion of calls dispatched with a medical condition in concordance with the ambulance personnel's assessment. Proportions were reported with 95% confidence intervals. χ-test was used for comparisons. P-levels < 0.05 were regarded as significant.
RESULTS
A total of 25,025 calls were included (EMD n = 23,723, EMD + RN n = 1302). Analyses relating to priority and medical condition were performed on 23,503 and 21,881 calls, respectively. A dispatched priority in concordance with the ambulance personnel's assessment were: EMD n = 11,319 (50.7%) and EMD + RN n = 481 (41.5%) (p < 0.01). The proportion of overtriage was equal for both groups: EMD n = 5904, EMD + RN n = 306, (26.4%) p = 0.25). The proportion of undertriage for each group was: EMD n = 5122 (22.9%) and EMD + RN n = 371 (32.0%) (p < 0.01). Sensitivity for the most urgent priority was 54.6% for EMD, compared to 29.6% for EMD + RN (p < 0.01), and specificity was 67.3% and 84.8% (p < 0.01) respectively. A dispatched medical condition in concordance with the ambulance personnel's assessment were: EMD n = 13,785 (66.4%) and EMD + RN n = 697 (62.2%) (p = 0.01).
CONCLUSIONS
A higher precision of emergency medical dispatching was not observed when the EMD was supported by an RN. How patient safety is affected by the observed divergence in dispatched priorities is an area for future research.
背景
对于紧急医疗调度员（EMD）的正规教育要求在国内外都存在争议和差异。关于紧急医疗调度相关的专业背景的研究结果很少。本研究旨在比较有和没有注册护士（RN）支持的 EMD 处理的呼叫，重点是优先级、准确性和医疗状况。
方法
这是一项回顾性观察性研究，对 2015 年特定地区的登记数据进行了分析。救护车人员对优先级和医疗状况的初步评估被用作参考标准。结果为：与救护车人员评估一致的优先级调度的呼叫比例；过度和不足分诊；最不利的过度和不足分诊的比例；每个救护车优先级的敏感性、特异性和预测值；与救护车人员评估一致的调度医疗状况的呼叫比例。报告了比例及其 95%置信区间。采用 χ 检验进行比较。p 值<0.05 被认为具有统计学意义。
结果
共纳入 25025 个呼叫（EMD n=23723，EMD+RN n=1302）。分别对与优先级和医疗状况相关的分析进行了 23503 次和 21881 次呼叫。与救护车人员评估一致的调度优先级为：EMD n=11319（50.7%）和 EMD+RN n=481（41.5%）（p<0.01）。两组的过度分诊比例相等：EMD n=5904，EMD+RN n=306（26.4%），p=0.25）。每个组的分诊不足比例为：EMD n=5122（22.9%）和 EMD+RN n=371（32.0%）（p<0.01）。EMD 的最紧急优先级的敏感性为 54.6%，而 EMD+RN 的敏感性为 29.6%（p<0.01），特异性分别为 67.3%和 84.8%（p<0.01）。与救护车人员评估一致的调度医疗状况为：EMD n=13785（66.4%）和 EMD+RN n=697（62.2%）（p=0.01）。
结论
当 EMD 得到 RN 的支持时，紧急医疗调度的精度并没有提高。观察到的调度优先级差异如何影响患者安全是未来研究的一个领域。
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