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Emergency Nursing Staff Dispatch: Sensitivity and Specificity in Detecting Prehospital Need for Physician Interventions During Ambulance Transport in Rovigo Emergency Ambulance Service, Italy

Published online by Cambridge University Press:  15 August 2013

Marco Leopardi  and
Marco Sommacampagna
Marco Leopardi*
Affiliation:
Centrale Operativa Provinciale Rovigo Emergenza, Ospedale S. Maria della Misericordia, Rovigo, Italy
Marco Sommacampagna
Affiliation:
Centrale Operativa Provinciale Rovigo Emergenza, Ospedale S. Maria della Misericordia, Rovigo, Italy
*
Correspondence: Marco Leopardi, MD SOC 118 Centrale Operativa Provinciale Rovigo Emergenza Azienda ULSS18 Viale Tre Martiri 45100, Rovigo, Italy E-mail leopardi.marco@azisanrovigo.it
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Abstract

Introduction

In Italy, administration of medications or advanced procedures dictates the prehospital presence of a physician to initiate treatment. Nursing staff is often used as dispatchers in Italian emergency medical ambulance services. There is little data about nursing dispatch performance in detecting high-acuity patients who need prehospital medications and procedures.

Objective

To determine the ability of a dispatch center staffed by emergency ambulance nurses to detect prehospital need for physician interventions in the context of a semi-rural area Emergency Medical Services system.

Methods

A retrospective analysis of 53,606 calls from the Rovigo Emergency Ambulance Services’ database was undertaken. Physician prehospital interventions were defined as the administration of medications or procedures (advanced airway management and ventilation, pneumothorax decompression, fluid replacement therapy, external defibrillation, cardioversion and pacing). The dispatch codes (assigned by a subjective decision-making process as Red, Yellow, or Green) of all transported prehospital patient calls were matched with an out-of-hospital triage system staffed by clinicians to determine the number of correctly identified prehospital need of physician interventions. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.

Results

The sensitivity of subjective experience-based nursing dispatch in detecting the need for physician interventions was 78.0% (95% CI, 76.9%-79.1%), with a PPV of 36.6% (95% CI, 35.8%-37.5%). Specificity was 83.8% (95% CI: 83.4%-84.1%), with an NPV of 96.9% (95% CI, 96.8%-97.1%).

Conclusion

A dispatch center staffed by nurses with six years of experience and three months of training correctly identified when not to send a doctor to the scene in the absence of need for physician interventions, using a subjective decision-making process. The nurses staffing the dispatch center also worked in the field. Dispatch center staff were not able to predict when there was no need for physician interventions in high-acuity dispatch code patients, resulting in an over-triage and use of emergency physicians on scene.

LeopardiM, SommacampagnaM.Emergency Nursing Staff Dispatch: Sensitivity and Specificity in Detecting Prehospital Need for Physician Interventions During Ambulance Transport in Rovigo Emergency Ambulance Service, Italy. Prehosp Disaster Med. 2013;28(5):1-6.

Keywords

communication systememergency careEmergency Medical Servicesphysicianprehospitaltriage
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 5 , October 2013 , pp. 523 - 528
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

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