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Using On-scene EMS Responders' Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers.
Prehosp Disaster Med. 2016 Feb; 31(1):46-57.PD

Abstract

INTRODUCTION

Using the Medical Priority Dispatch System (MPDS) - a systematic 911 triage process - to identify a large subset of low-acuity patients for secondary nurse triage in the 911 center is a largely unstudied practice in North America. This study examines the ALPHA-level subset of low-acuity patients in the MPDS to determine the suitability of these patients for secondary triage by evaluating vital signs and necessity of lights-and-siren transport, as determined by attending Emergency Medical Services (EMS) ambulance crews.

OBJECTIVES

The primary objective of this study was to determine the clinical status of MPDS ALPHA-level (low-acuity) patients, as determined by on-scene EMS crews' patient care records, in two US agencies. A secondary objective was to determine which ALPHA-level codes are suitable candidates for secondary triage by a trained Emergency Communication Nurse (ECN).

METHODS

In this retrospective study, one full year (2013) of both dispatch data and EMS patient records data, associated with all calls coded at the ALPHA-level (low-acuity) in the dispatch protocol, were collected. The primary outcome measure was the number and percentage of ALPHA-level codes categorized as low-acuity, moderate-acuity, high-acuity, and critical using four common vital signs to assign these categories: systolic blood pressure (SBP), pulse rate (PR), oxygen saturation (SpO2), and Glasgow Coma Score (GCS). Vital sign data were obtained from ambulance crew electronic patient care records (ePCRs). The secondary endpoint was the number and percentage of ALPHA-level codes that received a "hot" (lights-and-siren) transport.

RESULTS

Out of 19,300 cases, 16,763 (86.9%) were included in the final analysis, after excluding cases from health care providers and those with missing data. Of those, 89% of all cases did not have even one vital sign indicator of unstable patient status (high or critical vital sign). Of all cases, only 1.1% were transported lights-and-siren.

CONCLUSION

With the exception of the low-acuity, ALPHA-level seizure cases, the ALPHA-level patients are suitable to transfer for secondary triage in a best-practices, accredited, emergency medical dispatch center that utilizes the MPDS at very high compliance rates. The secondary nurse triage process should identify the few at-risk patients that exist in the low-acuity calls.

Authors+Show Affiliations

1Research and Standards Division,International Academies of Emergency Dispatch,Salt Lake City,UtahUSA.1Research and Standards Division,International Academies of Emergency Dispatch,Salt Lake City,UtahUSA.2Administration,Priority Solutions Inc.,Salt Lake City,UtahUSA.2Administration,Priority Solutions Inc.,Salt Lake City,UtahUSA.1Research and Standards Division,International Academies of Emergency Dispatch,Salt Lake City,UtahUSA.4Emergency Medical Services Authority,Tulsa,OklahomaUSA.5Salt Lake City Fire Department,Salt Lake City,UtahUSA.1Research and Standards Division,International Academies of Emergency Dispatch,Salt Lake City,UtahUSA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26758527

Citation

Scott, Greg, et al. "Using On-scene EMS Responders' Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers." Prehospital and Disaster Medicine, vol. 31, no. 1, 2016, pp. 46-57.
Scott G, Clawson J, Fivaz MC, et al. Using On-scene EMS Responders' Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers. Prehosp Disaster Med. 2016;31(1):46-57.
Scott, G., Clawson, J., Fivaz, M. C., McQueen, J., Gardett, M. I., Schultz, B., Youngquist, S., & Olola, C. H. (2016). Using On-scene EMS Responders' Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers. Prehospital and Disaster Medicine, 31(1), 46-57. https://doi.org/10.1017/S1049023X15005567
Scott G, et al. Using On-scene EMS Responders' Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers. Prehosp Disaster Med. 2016;31(1):46-57. PubMed PMID: 26758527.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Using On-scene EMS Responders' Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers. AU - Scott,Greg, AU - Clawson,Jeff, AU - Fivaz,Mark C, AU - McQueen,Jennie, AU - Gardett,Marie I, AU - Schultz,Bryon, AU - Youngquist,Scott, AU - Olola,Christopher H O, Y1 - 2016/01/13/ PY - 2016/1/14/entrez PY - 2016/1/14/pubmed PY - 2017/2/14/medline KW - ACE Accredited Center of Excellence KW - BLS Basic Life Support KW - ECN Emergency Communication Nurse KW - ECNS Emergency Communication Nurse System KW - EMD Emergency Medical Dispatcher KW - EMS Emergency Medical Services KW - EMS communication systems KW - EMT Emergency Medical Technician KW - GCS Glasgow Coma Score KW - IAED International Academies of Emergency Dispatch KW - MPDS Medical Priority Dispatch System KW - Medical Priority Dispatch System KW - PR pulse rate KW - SBP systolic blood pressure KW - SpO2 pulse oximetry reading KW - dispatch priority levels KW - ePCR electronic patient care record KW - electronic patient care record KW - low-acuity calls KW - secondary nurse triage system SP - 46 EP - 57 JF - Prehospital and disaster medicine JO - Prehosp Disaster Med VL - 31 IS - 1 N2 - INTRODUCTION: Using the Medical Priority Dispatch System (MPDS) - a systematic 911 triage process - to identify a large subset of low-acuity patients for secondary nurse triage in the 911 center is a largely unstudied practice in North America. This study examines the ALPHA-level subset of low-acuity patients in the MPDS to determine the suitability of these patients for secondary triage by evaluating vital signs and necessity of lights-and-siren transport, as determined by attending Emergency Medical Services (EMS) ambulance crews. OBJECTIVES: The primary objective of this study was to determine the clinical status of MPDS ALPHA-level (low-acuity) patients, as determined by on-scene EMS crews' patient care records, in two US agencies. A secondary objective was to determine which ALPHA-level codes are suitable candidates for secondary triage by a trained Emergency Communication Nurse (ECN). METHODS: In this retrospective study, one full year (2013) of both dispatch data and EMS patient records data, associated with all calls coded at the ALPHA-level (low-acuity) in the dispatch protocol, were collected. The primary outcome measure was the number and percentage of ALPHA-level codes categorized as low-acuity, moderate-acuity, high-acuity, and critical using four common vital signs to assign these categories: systolic blood pressure (SBP), pulse rate (PR), oxygen saturation (SpO2), and Glasgow Coma Score (GCS). Vital sign data were obtained from ambulance crew electronic patient care records (ePCRs). The secondary endpoint was the number and percentage of ALPHA-level codes that received a "hot" (lights-and-siren) transport. RESULTS: Out of 19,300 cases, 16,763 (86.9%) were included in the final analysis, after excluding cases from health care providers and those with missing data. Of those, 89% of all cases did not have even one vital sign indicator of unstable patient status (high or critical vital sign). Of all cases, only 1.1% were transported lights-and-siren. CONCLUSION: With the exception of the low-acuity, ALPHA-level seizure cases, the ALPHA-level patients are suitable to transfer for secondary triage in a best-practices, accredited, emergency medical dispatch center that utilizes the MPDS at very high compliance rates. The secondary nurse triage process should identify the few at-risk patients that exist in the low-acuity calls. SN - 1945-1938 UR - https://www.unboundmedicine.com/medline/citation/26758527/Using_On_scene_EMS_Responders'_Assessment_and_Electronic_Patient_Care_Records_to_Evaluate_the_Suitability_of_EMD_triaged_Low_acuity_Calls_for_Secondary_Nurse_Triage_in_911_Centers_ L2 - https://www.cambridge.org/core/product/identifier/S1049023X15005567/type/journal_article DB - PRIME DP - Unbound Medicine ER -