Abstract
Methods: 119 scenarios were constructed based on calls to ambulance services that had been assigned the lowest priority category by the emergency medical dispatch systems in use. These scenarios were presented to nurses working in four NHS Direct call centres using different computerised decision support software, including the NHS Clinical Assessment System.
Results: The overall level of agreement between the nurses using the four systems was "fair" rather than "moderate" or "good" (κ=0.375, 95% CI: 0.34 to 0.41). For example, the proportion of calls triaged to accident and emergency departments varied from 22% (26 of 119) to 44% (53 of 119). Between 21% (25 of 119) and 31% (37 of 119) of these low priority ambulance calls were triaged back to the 999 ambulance service. No system had both high sensitivity and specificity for referral to accident and emergency services.
Conclusions: There were large differences in outcome between nurses using different software systems to triage the same calls. If the variation is primarily attributable to the software then standardising on a single system will obviously eliminate this. As the calls were originally made to ambulance services and given the lowest priority, this study also suggests that if, in the future, ambulance services pass such calls to NHS Direct then at least a fifth of these may be passed back unless greater sensitivity in the selection of calls can be achieved.
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Selected References
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- Brennan P., Silman A. Statistical methods for assessing observer variability in clinical measures. BMJ. 1992 Jun 6;304(6840):1491–1494. doi: 10.1136/bmj.304.6840.1491. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gaffney P., Crane S., Johnson G., Playforth M. An analysis of calls referred to the emergency 999 service by NHS Direct. Emerg Med J. 2001 Jul;18(4):302–304. doi: 10.1136/emj.18.4.302. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jones J., Playforth M. J. The effect of the introduction of NHS Direct on requests for telephone advice from an accident and emergency department. Emerg Med J. 2001 Jul;18(4):300–301. doi: 10.1136/emj.18.4.300. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kalf A. J., Spruijt-Metz D. Variation in diagnoses: influence of specialists' training on selecting and ranking relevant information in geriatric case vignettes. Soc Sci Med. 1996 Mar;42(5):705–712. doi: 10.1016/0277-9536(95)00201-4. [DOI] [PubMed] [Google Scholar]
- Lee R., MacFarlane T., O'Brien K. Consistency of orthodontic treatment planning decisions. Clin Orthod Res. 1999 May;2(2):79–84. doi: 10.1111/ocr.1999.2.2.79. [DOI] [PubMed] [Google Scholar]
- Leprohon J., Patel V. L. Decision-making strategies for telephone triage in emergency medical services. Med Decis Making. 1995 Jul-Sep;15(3):240–253. doi: 10.1177/0272989X9501500307. [DOI] [PubMed] [Google Scholar]
- Lowy A., Kohler B., Nicholl J. Attendance at accident and emergency departments: unnecessary or inappropriate? J Public Health Med. 1994 Jun;16(2):134–140. doi: 10.1093/oxfordjournals.pubmed.a042947. [DOI] [PubMed] [Google Scholar]
- Munro J., Nicholl J., O'Cathain A., Knowles E. Impact of NHS direct on demand for immediate care: observational study. BMJ. 2000 Jul 15;321(7254):150–153. doi: 10.1136/bmj.321.7254.150. [DOI] [PMC free article] [PubMed] [Google Scholar]
- O'Cathain A., Munro J. F., Nicholl J. P., Knowles E. How helpful is NHS direct? Postal survey of callers. BMJ. 2000 Apr 15;320(7241):1035–1035. doi: 10.1136/bmj.320.7241.1035. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Salisbury Chris, Chalder Mel, Scott Taj Manku, Pope Catherine, Moore Laurence. What is the role of walk-in centres in the NHS? BMJ. 2002 Feb 16;324(7334):399–402. doi: 10.1136/bmj.324.7334.399. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wachter D. A., Brillman J. C., Lewis J., Sapien R. E. Pediatric telephone triage protocols: standardized decisionmaking or a false sense of security? Ann Emerg Med. 1999 Apr;33(4):388–394. doi: 10.1016/s0196-0644(99)70301-x. [DOI] [PubMed] [Google Scholar]