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2 results

  • Improving the Appropriateness of Advanced Life Support Teams’ Dispatch: A Before-After Study

  • Lorenzo Gamberini, Cosimo Picoco, Donatella Del Giudice, Corrado Zenesini, Marco Tartaglione, Carlo Coniglio, Federico Semeraro, Fabrizio Bizzi, Stefano Santini, Giovanni Gordini
  • Journal:
    Prehospital and Disaster Medicine / Volume 36 / Issue 2 / April 2021
    Published online by Cambridge University Press:
    01 February 2021, pp. 195-201
    Print publication:
    April 2021
  • Background and Importance:

    The dispatch of Advanced Life Support (ALS) teams in Emergency Medical Services (EMS) is still a hardly studied aspect of prehospital emergency logistics. In 2015, the dispatch algorithm of Emilia Est Emergency Operation Centre (EE-EOC) was implemented and the dispatch of ALS teams was changed from primary to secondary based on triage of dispatched vehicles for high-priority interventions when teams with Immediate Life Support (ILS) skills were dispatched.

    Objectives:

    This study aimed to evaluate the effects on the appropriateness of ALS teams’ intervention and their employment time, and to compare sensitivity and specificity of the algorithm implementation.

    Design:

    This was a retrospective before-after observational study.

    Settings and Participants:

    Primary dispatches managed by EE-EOC involving ambulances and/or ALS teams were included. Two groups were created on the basis of the years of intervention (2013-2014 versus 2017-2018).

    Intervention:

    A switch from primary to secondary dispatch of ALS teams in case of high-priority dispatches managed by ILS teams was implemented.

    Outcomes:

    Appropriateness of ALS team intervention, total task time of ALS vehicles, and sensitivity and specificity of the algorithm were reviewed.

    Results:

    The study included 242,501 emergency calls that generated 56,567 red code dispatches. The new algorithm significantly increased global sensitivity and specificity of the system in terms of recognition of potential need of ALS intervention and the specificity of primary ALS dispatch. The appropriateness of ALS intervention was significantly increased; total tasking time per day for ALS and the number of critical dispatches without ALS available were reduced.

    Conclusion:

    The revision of the dispatch criteria and the extension of the two-tiered dispatch for ALS teams significantly increased the appropriateness of ALS intervention and reduced both the global tasking time and the number of high-priority dispatches without ALS teams available.

  • ORDER SETS IN HEALTH CARE: A SYSTEMATIC REVIEW OF THEIR EFFECTS

  • Alvita J. Chan, Julie Chan, Joseph A. Cafazzo, Peter G. Rossos, Tim Tripp, Kaveh Shojania, Tanya Khan, Anthony C. Easty
  • Journal:
    International Journal of Technology Assessment in Health Care / Volume 28 / Issue 3 / July 2012
    Published online by Cambridge University Press:
    14 September 2012, pp. 235-240

  • Objectives: Order sets are widely used in hospitals to enter diagnosis and treatment orders. To determine the effectiveness of order sets in improving guideline adherence, treatment outcomes, processes of care, efficiency, and cost, we conducted a systematic review of the literature.

    Methods: A comprehensive literature search was performed in various databases for studies published between January 1, 1990, and April 18, 2009. A total of eighteen studies met inclusion criteria. No randomized controlled trials were found.

    Results: Outcomes of the included studies were summarized qualitatively due to variations in study population, intervention type, and outcome measures. There were no important inconsistencies between the results reported by studies involving different types of order sets. While the studies generally suggested positive outcomes, they were typically of low quality, with simple before-after designs and other methodological limitations.

    Conclusions: The benefits of order sets remain eminently plausible, but given the paucity of high quality evidence, further investigations to formally evaluate the effectiveness of order sets would be highly valuable.