Pre-hospital over-triage and potential contributing factors in Cape Town, South Africa
AbstractBackground: Inappropriate dispatch of urgent ambulances by call-centre personnel causes an unnecessary drain on existing resources. How often these urgent dispatches are appropriate has not been evaluated in the lower-middle-income setting, nor have factors been assessed that contribute to these decisions. This study aimed to establish the rates of pre-hospital over-triage in Cape Town, South Africa, and to assess the call-centre decision-making processes.Â Methods: This was a descriptive, retrospective study examining all urgent ambulance dispatches made from a large public sector ambulance call centre in Cape Town over a single month. This urgent dispatch was then compared to the on-scene South African Triage Scale (SATS) score assigned by the pre-hospital personnel to assess which cases were â€˜over-triagedâ€™ by the call taker. Factors potentially contributing to the call takerâ€™s decision were also analysed and included the time of day, nature of presenting complaint, and the call takerâ€™s training and experience â€“ all of which may have affected the rates of over-triage.Results: In the course of one month in 2017, 4,169 urgent calls were assessed; of these, 2,701 were over-triaged (58.48%). The over-triage rate was similar during the day (58.02%) and night (59.11%). The most regularly over-triaged complaint was obstetric and gynaecological (84.87%), followed by motor vehicle accidents (65.70%); the lowest rate was for cardiac call-outs (47.12%). We reviewed the 38 highest workload call takers, and found no statistically significant factors that contributed to higher levels of over-triage when reviewing higher levels of training (Ambulance Emergency Assistant 62.16%, no medical training 59.42%; p=0.669), more years as a call taker (< 2 years 59.32%, > 5 years 60.23%; p=0.932), and more years working in the field (0 years 59.36%, > 5 years 63.66%; p=0.305).Conclusion: The rates of pre-hospital over-triage in Cape Town are marginally lower than those described internationally. The nature of the complaint had a strong impact on these rates, notably in terms of trauma and gynaecological disorders. The call takerâ€™s training and years of experience did not have a statistically significant impact on decision-making.
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