The clinical, organisational and cost consequences of computer-assisted telephone advice to category C 999 ambulance service callers: results of a controlled trial

• Register: ISRCTN
• Last refreshed on: 13 January 2015
• Main ID: ISRCTN30837187
• Date of registration: 23/01/2004
• Prospective Registration: No
• Primary sponsor: Record Provided by the NHS R&D 'Time-Limited' National Programme Register - Department of Health (UK)
• Public title: The clinical, organisational and cost consequences of computer-assisted telephone advice to category C 999 ambulance service callers: results of a controlled trial
• Date of first enrolment: 01/04/1997
• Target sample size: 0
• Recruitment status: Completed
• URL: http://isrctn.com/ISRCTN30837187
• Study type: Interventional
• Study design: Randomised controlled trial (Other)

Countries of recruitment

United Kingdom

Contacts

• Name: Jeremy Dale

Key inclusion & exclusion criteria

Inclusion criteria: The trial was conducted at two sites: the London Ambulance Service and the West Midlands Ambulance Service. Data collection for the main study was undertaken over a period of 12 months. All calls to the 999 ambulance service prioritised by call-takers as presenting with non-urgent (Category C) problems during sampled sessions.
Exclusion criteria: Not provided at time of registration

Age minimum:
Age maximum:
Gender: Both

Health Condition(s) or Problem(s) studied

Computer-assisted telephone advice for emergency services
Not Applicable

Intervention(s)

Time blocks of 3-4 hours were allocated randomly within the constraints of staff availability to intervention sessions (nurse assessment and triage, or paramedic assessment and triage) and control sessions. During intervention sessions, nurses or paramedics trained in telephone consulting skills and using the TAS computerised decision support system assessed the patients' needs for emergency ambulances and, if appropriate, offered advice. The intervention ran in 'shadow' form (i.e. all ambulances were dispatched in the usual way), but calls assessed as appropriate for advice were given an opportunity to decline the ambulance.

Primary Outcome(s)

1. Triage assessment made by the paramedic or nurse
2. Subsequent cancellation of ambulance
3. Caller/patient satisfaction
4. Health outcome
5. SF-12 one week after 999 call
6. Review of nurse/paramedic decision making by independent clinical panel
7. Economic analysis of findings. The findings indicate that the provision of telephone assessment and advice to Category C callers is both safe and acceptable to callers. Telephone assessment and advice could enable patients with no identified clinical need for an emergency ambulance to be offered more appropriate care for their presenting condition. In the ambulance services studied, this could lead to at least 7-10% of dispatches being cancelled, so enabling improved response times for patients with more critical or life-threatening needs. Nurses using computer assisted decision support were more effective at identifying patients not in need of emergency ambulance than were paramedics using the decision support. The savings in marginal costs to the ambulance service appear likely to outweigh the costs of providing the telephone triage intervention. There are also likely to be considerable savings to AEDs as a result of reduced attendances.

Secondary Outcome(s)

Not provided at time of registration

Secondary ID(s)

PSI E-21

Source(s) of Monetary Support

NHS Primary and Secondary Care Interface National Research and Development Programme (UK)