PMID- 28407809
OWN - NLM
STAT- MEDLINE
DCOM- 20170831
LR  - 20181113
IS  - 1757-7241 (Electronic)
IS  - 1757-7241 (Linking)
VI  - 25
IP  - 1
DP  - 2017 Apr 13
TI  - Merger of two dispatch centres: does it improve quality and patient safety?
PG  - 40
LID - 10.1186/s13049-017-0383-z [doi]
LID - 40
AB  - BACKGROUND: 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. METHODS: 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. RESULTS: 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.
FAU - Moser, Alexandre
AU  - Moser A
AUID- ORCID: 0000-0002-0385-0479
AD  - Emergency Department, Hopital Neuchatelois, Maladiere 45, 2000, Neuchatel, 
      Switzerland. alexandre.moser@ssvnn.net.
FAU - Mettler, Annette
AU  - Mettler A
AD  - Emergency Department, Hopital Neuchatelois, Maladiere 45, 2000, Neuchatel, 
      Switzerland.
FAU - Fuchs, Vincent
AU  - Fuchs V
AD  - Dispatch Centre, State of Vaud (Fondation Urgences-Sante), Cesar-Roux 31, 1005, 
      Lausanne, Switzerland.
FAU - Hanhart, Walter
AU  - Hanhart W
AD  - Emergency Department, Hopital Neuchatelois, Maladiere 45, 2000, Neuchatel, 
      Switzerland.
FAU - Robert, Claude-Francois
AU  - Robert CF
AD  - State of Neuchatel, Public Health Office, Jacque-Louis De Pourtales 2, 2000, 
      Neuchatel, Switzerland.
FAU - Della Santa, Vincent
AU  - Della Santa V
AD  - Emergency Department, Hopital Neuchatelois, Maladiere 45, 2000, Neuchatel, 
      Switzerland.
FAU - Dami, Fabrice
AU  - Dami F
AD  - Dispatch Centre, State of Vaud (Fondation Urgences-Sante), Cesar-Roux 31, 1005, 
      Lausanne, Switzerland.
AD  - Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20170413
PL  - England
TA  - Scand J Trauma Resusc Emerg Med
JT  - Scandinavian journal of trauma, resuscitation and emergency medicine
JID - 101477511
SB  - IM
MH  - Emergency Medical Dispatch/organization & administration/*standards
MH  - Humans
MH  - *Patient Safety
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
MH  - Switzerland
MH  - Triage/*standards
PMC - PMC5390381
OTO - NOTNLM
OT  - Criteria-based dispatch centre (CBD)
OT  - Merger
OT  - Over- and under-triage
OT  - Patient safety
OT  - Prehospital triage
EDAT- 2017/04/15 06:00
MHDA- 2017/09/01 06:00
PMCR- 2017/04/13
CRDT- 2017/04/15 06:00
PHST- 2016/12/30 00:00 [received]
PHST- 2017/04/03 00:00 [accepted]
PHST- 2017/04/15 06:00 [entrez]
PHST- 2017/04/15 06:00 [pubmed]
PHST- 2017/09/01 06:00 [medline]
PHST- 2017/04/13 00:00 [pmc-release]
AID - 10.1186/s13049-017-0383-z [pii]
AID - 383 [pii]
AID - 10.1186/s13049-017-0383-z [doi]
PST - epublish
SO  - Scand J Trauma Resusc Emerg Med. 2017 Apr 13;25(1):40. doi: 
      10.1186/s13049-017-0383-z.