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

Plain English Summary

Not provided at time of registration

Study website

Type

Scientific

Contact name

Prof Jeremy Dale

ORCID ID

Contact details

Centre for Primary Health Care Studies
University of Warwick
Coventry
CV4 7AL
United Kingdom
+44 (0)2476 524254
jeremy.dale@warwick.ac.uk

EudraCT/CTIS number

IRAS number

ClinicalTrials.gov number

Protocol/serial number

PSI E-21

Scientific title

Acronym

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

Study design

Randomised controlled trial

Primary study design

Interventional

Secondary study design

Randomised controlled trial

Study setting(s)

Other

Study type

Other

Patient information sheet

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

Reason abandoned (if study stopped)

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 type(s)

Patient

Age group

Other

Sex

Both

Target number of participants

Not provided at time of registration

Participant exclusion criteria

Not provided at time of registration

Recruitment start date

01/04/1997

Recruitment end date

01/04/2000

Countries of recruitment

England, United Kingdom

Study participating centre

Centre for Primary Health Care Studies
Coventry
CV4 7AL
United Kingdom

Organisation

Record Provided by the NHS R&D 'Time-Limited' National Programme Register - Department of Health (UK)

Sponsor details

The Department of Health
Richmond House
79 Whitehall
London
SW1A 2NL
United Kingdom

Sponsor type

Government

Website

http://www.doh.gov.uk

Funder type

Government

Funder name

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

Alternative name(s)

Funding Body Type

Funding Body Subtype

Location

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Individual participant data (IPD) sharing plan

IPD sharing plan summary

Not provided at time of registration

Study outputs