The clinical, organisational and cost consequences of computer-assisted telephone advice to category C 999 ambulance service callers: results of a controlled trial
| ISRCTN | ISRCTN30837187 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN30837187 |
| Secondary identifying numbers | PSI E-21 |
- Submission date
- 23/01/2004
- Registration date
- 23/01/2004
- Last edited
- 18/11/2009
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Other
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Plain English Summary
Not provided at time of registration
Contact information
Prof Jeremy Dale
Scientific
Scientific
Centre for Primary Health Care Studies
University of Warwick
Coventry
CV4 7AL
United Kingdom
| Phone | +44 (0)2476 524254 |
|---|---|
| jeremy.dale@warwick.ac.uk |
Study information
| Study design | Randomised controlled trial |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Randomised controlled trial |
| Study setting(s) | Other |
| Study type | Other |
| Scientific title | |
| Study hypothesis | The aims of the study were: 1. To investigate the efficacy and safety of telephone assessment and advice to Category C (non-urgent) 999 ambulance service callers as an alternative to despatching an ambulance 2. To investigate the acceptability of telephone assessment and advice to Category C 999 ambulance service callers 3. To compare the efficacy, safety and acceptability of nurses and paramedics as providers of telephone advice to Category C 999 ambulance service callers 4. To model the cost consequences of telephone assessment and advice to Category C 999 ambulance callers |
| Ethics approval(s) | Not provided at time of registration |
| Condition | Computer-assisted telephone advice for emergency services |
| Intervention | 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. |
| Intervention type | Other |
| Primary outcome measure | 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 measures | Not provided at time of registration |
| Overall study start date | 01/04/1997 |
| Overall study end date | 01/04/2000 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Other |
| Sex | Both |
| Target number of participants | Not provided at time of registration |
| Participant 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. |
| Participant exclusion criteria | Not provided at time of registration |
| Recruitment start date | 01/04/1997 |
| Recruitment end date | 01/04/2000 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centre
Centre for Primary Health Care Studies
Coventry
CV4 7AL
United Kingdom
CV4 7AL
United Kingdom
Sponsor information
Record Provided by the NHS R&D 'Time-Limited' National Programme Register - Department of Health (UK)
Government
Government
The Department of Health
Richmond House
79 Whitehall
London
SW1A 2NL
United Kingdom
| Website | http://www.doh.gov.uk |
|---|
Funders
Funder type
Government
NHS Primary and Secondary Care Interface National Research and Development Programme (UK)
No information available
Results and Publications
| Intention to publish date | |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Not provided at time of registration |
| Publication and dissemination plan | Not provided at time of registration |
| IPD sharing plan |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Results article | results | 01/03/2003 | Yes | No | |
| Results article | 2, results | 01/10/2004 | Yes | No |
