Using trigger tools to identify triage errors by ambulance dispatch nurses in Sweden: an observational study
Objectives This study aimed to assess whether trigger tools were useful identifying triage errors among patients referred to non-emergency care by emergency medical dispatch nurses, and to describe the characteristics of these patients.Design An observational study of patients referred by dispatch n...
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BMJ Publishing Group
2020-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/3/e035004.full |
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| author | Ulrika Winblad Douglas Spangler Lennart Edmark Jessica Colldén-Benneck Helena Borg Hans Blomberg |
| author_facet | Ulrika Winblad Douglas Spangler Lennart Edmark Jessica Colldén-Benneck Helena Borg Hans Blomberg |
| author_sort | Ulrika Winblad |
| collection | DOAJ |
| description | Objectives This study aimed to assess whether trigger tools were useful identifying triage errors among patients referred to non-emergency care by emergency medical dispatch nurses, and to describe the characteristics of these patients.Design An observational study of patients referred by dispatch nurses to non-emergency care.Setting Dispatch centres in two Swedish regions.Participants A total of 1089 adult patients directed to non-emergency care by dispatch nurses between October 2016 and February 2017. 53% were female and the median age was 61 years.Primary and secondary outcome measures The primary outcome was a visit to an emergency department within 7 days of contact with the dispatch centre. Secondary outcomes were (1) visits related to the primary contact with the dispatch centre, (2) provision of care above the primary level (ie, interventions not available at a typical local primary care centre) and (3) admission to hospital in-patient care.Results Of 1089 included patients, 260 (24%) visited an emergency department within 7 days. Of these, 209 (80%) were related to the dispatch centre contact, 143 (55%) received interventions above the primary care level and 99 (38%) were admitted to in-patient care. Elderly (65+) patients (OR 1.45, 95% CI 1.05 to 1.98) and patients referred onwards to other healthcare providers (OR 1.58, 95% CI 1.15 to 2.19) had higher likelihoods of visiting an emergency department. Six avoidable patient harms were identified, none of which were captured by existing incident reporting systems, and all of which would have received an ambulance if the decision support system had been strictly adhered to.Conclusion The use of these patient outcomes in the framework of a Global Trigger Tool-based review can identify patient harms missed by incident reporting systems in the context of emergency medical dispatching. Increased compliance with the decision support system has the potential to improve patient safety. |
| format | Article |
| id | doaj-art-160f9f1f47b34a3da95d3027ba409a1c |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-160f9f1f47b34a3da95d3027ba409a1c2025-08-20T02:20:06ZengBMJ Publishing GroupBMJ Open2044-60552020-03-0110310.1136/bmjopen-2019-035004Using trigger tools to identify triage errors by ambulance dispatch nurses in Sweden: an observational studyUlrika Winblad0Douglas Spangler1Lennart Edmark2Jessica Colldén-Benneck3Helena Borg4Hans Blomberg56 Department of Public Health and Caring Sciences, Uppsala University, Uppsala, SwedenDepartment of Surgical Sciences—Anesthesia and Intensive Care, Uppsala Center for Prehospital Research, Uppsala University, Uppsala, SwedenDepartment of Anesthesia and Intensive Care, Västmanlands sjukhus Västerås, Vasteras, SwedenDepartment of Surgical Sciences—Anesthesia and Intensive Care, Uppsala Center for Prehospital Research, Uppsala University, Uppsala, SwedenAmbulance Department, Västmanlands sjukhus Västerås, Vasteras, SwedenDepartment of Surgical Sciences—Anesthesia and Intensive Care, Uppsala Center for Prehospital Research, Uppsala University, Uppsala, SwedenObjectives This study aimed to assess whether trigger tools were useful identifying triage errors among patients referred to non-emergency care by emergency medical dispatch nurses, and to describe the characteristics of these patients.Design An observational study of patients referred by dispatch nurses to non-emergency care.Setting Dispatch centres in two Swedish regions.Participants A total of 1089 adult patients directed to non-emergency care by dispatch nurses between October 2016 and February 2017. 53% were female and the median age was 61 years.Primary and secondary outcome measures The primary outcome was a visit to an emergency department within 7 days of contact with the dispatch centre. Secondary outcomes were (1) visits related to the primary contact with the dispatch centre, (2) provision of care above the primary level (ie, interventions not available at a typical local primary care centre) and (3) admission to hospital in-patient care.Results Of 1089 included patients, 260 (24%) visited an emergency department within 7 days. Of these, 209 (80%) were related to the dispatch centre contact, 143 (55%) received interventions above the primary care level and 99 (38%) were admitted to in-patient care. Elderly (65+) patients (OR 1.45, 95% CI 1.05 to 1.98) and patients referred onwards to other healthcare providers (OR 1.58, 95% CI 1.15 to 2.19) had higher likelihoods of visiting an emergency department. Six avoidable patient harms were identified, none of which were captured by existing incident reporting systems, and all of which would have received an ambulance if the decision support system had been strictly adhered to.Conclusion The use of these patient outcomes in the framework of a Global Trigger Tool-based review can identify patient harms missed by incident reporting systems in the context of emergency medical dispatching. Increased compliance with the decision support system has the potential to improve patient safety.https://bmjopen.bmj.com/content/10/3/e035004.full |
| spellingShingle | Ulrika Winblad Douglas Spangler Lennart Edmark Jessica Colldén-Benneck Helena Borg Hans Blomberg Using trigger tools to identify triage errors by ambulance dispatch nurses in Sweden: an observational study BMJ Open |
| title | Using trigger tools to identify triage errors by ambulance dispatch nurses in Sweden: an observational study |
| title_full | Using trigger tools to identify triage errors by ambulance dispatch nurses in Sweden: an observational study |
| title_fullStr | Using trigger tools to identify triage errors by ambulance dispatch nurses in Sweden: an observational study |
| title_full_unstemmed | Using trigger tools to identify triage errors by ambulance dispatch nurses in Sweden: an observational study |
| title_short | Using trigger tools to identify triage errors by ambulance dispatch nurses in Sweden: an observational study |
| title_sort | using trigger tools to identify triage errors by ambulance dispatch nurses in sweden an observational study |
| url | https://bmjopen.bmj.com/content/10/3/e035004.full |
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