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Dispatcher Triage Accuracy in the Western Cape Government Emergency Medical Services System, Cape Town, South Africa

Published online by Cambridge University Press:  25 August 2020

Mohammed F. Alshehri ,
Jennifer L. Pigoga Open the ORCID record for Jennifer L. Pigoga [Opens in a new window]  and
Lee A. Wallis
Mohammed F. Alshehri
Affiliation:
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
Jennifer L. Pigoga*
Affiliation:
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
Lee A. Wallis
Affiliation:
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
*
Correspondence: Jennifer Pigoga University of Cape Town Anzio Road Observatory, Cape Town, 7935South Africa E-mail: jennpigoga@gmail.com
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Abstract

Introduction:

Triage - the sorting of patients according to urgency of need for clinical care - is an essential part of delivering effective and efficient emergency care. But when frequent over- or under-triaging occurs, finite time and resources are diverted away from those in greatest need of care and the entire Emergency Medical Services (EMS) system is strained. In resource-constrained settings, such as South Africa, poor triage in EMS only serves to compound other contextual challenges. This study examined the accuracy of dispatcher triage over a one-year period in the Western Cape Government (WCG) EMS system in South Africa.

Methods:

A retrospective analysis of existing dispatch and EMS data to assess the accuracy of dispatch-assigned priorities was conducted. The mismatch between dispatcher-assigned call priority and triage levels determined by EMS personnel was analyzed via over- and under-triage rates, sensitivity and specificity, and positive and negative predictive values (PPVs and NPVs, respectively).

Results:

A total of 185,166 records from December 2016 through November 2017 were analyzed. Across all dispatch complaints, the over-triage rate was 67.6% (95% CI, 66.34-68.76) and the under-triage rate was 16.2% (95% CI, 15.44-16.90). Dispatch triage sensitivity for all included records was 49.2% (95% CI, 48.10-50.38), specificity 71.9% (95% CI, 71.00-72.92), PPV 32.5% (95% CI, 30.02-34.88), and NPV 83.8% (95% CI, 81.93-85.73).

Conclusion:

This study provides the first evaluation of dispatch triage accuracy in the WCG EMS system, identifying that the system is suffering from both under- and over-triage. Despite variance across dispatch complaints, both under- and over-triage remained higher than widely accepted norms, and all rates were significantly above acceptable target metrics described in similar studies. Results of this study will be used to motivate the development of more rigorous training programs and resources for WCG EMS dispatchers, including improved dispatch protocols for conditions suffering from high over- and under-triage.

Keywords

Emergency Medical Servicesemergency medicineprehospital caretriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 6 , December 2020 , pp. 638 - 644
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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