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
Protocol serial number	PSI E-21
Sponsor	Record Provided by the NHS R&D 'Time-Limited' National Programme Register - Department of Health (UK)
Funder	NHS Primary and Secondary Care Interface National Research and Development Programme (UK)

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 of protocol

Not provided at time of registration

Contact information

Prof Jeremy Dale
Scientific

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

Phone	+44 (0)2476 524254
Email	jeremy.dale@warwick.ac.uk

Study information

Primary study design	Interventional
Study design	Randomised controlled trial
Secondary study design	Randomised controlled trial
Scientific title
Study objectives	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
Health condition(s) or problem(s) studied	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(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.
Key secondary outcome measure(s)	Not provided at time of registration
Completion date	01/04/2000

Eligibility

Participant type(s)	Patient
Age group	Other
Sex	All
Key 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.
Key exclusion criteria	Not provided at time of registration
Date of first enrolment	01/04/1997
Date of final enrolment	01/04/2000

Locations

Countries of recruitment

United Kingdom
England

Study participating centre

Centre for Primary Health Care Studies

Coventry
CV4 7AL
United Kingdom

Results and Publications

Individual participant data (IPD) Intention to share	No
IPD sharing plan summary	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