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Patient-focused triage leads to better outcomes

March 28, 2018 | in Community News

Further details about how Ambulance Victoria prioritises emergency ambulances to patients in most urgent need through changes to the way Triple Zero (000) calls are triaged and ambulances are dispatched have been released.

These changes, which have been in operation since October 2016 as part of revisions made to Ambulance Victoria’s Clinical Response Model, are published here on the Ambulance Victoria website.

The publication follows a Freedom of Information (FOI) request for information relating to the dispatch grid changes. Ambulance Victoria was concerned that the complex data used to inform how cases are coded and ambulances are dispatched could be easily misinterpreted by the public.

The Office of the Victorian Information Commissioner advised that it was in the public interest for Ambulance Victoria to detail the changes made and help the community understand the complexity of how cases are coded, how urgent needs are prioritised and how ambulances are dispatched.

Ambulance Victoria CEO Tony Walker said it was important for the public to be confident that Triple Zero (000) calls were being appropriately assessed and decisions made based on individual patient needs.

“Ambulance Victoria respects the decision of the Office of the Victorian Information Commissioner and understands the importance of informing the community about changes to how we dispatch ambulances,” Associate Professor Walker said.

“Victorians can be assured that when they call Triple Zero (000) and they need an emergency ambulance they will get one and they will get it more quickly, especially those people who are in a time-critical and life-threatening emergency.”

“Changes we have made to our triage system have been independently assessed, oversighted and examined by medical experts. The changes have now been in place for 16 months and are leading to better patient outcomes and more lives being saved, even with an increase in calls to Triple Zero (000).”

“We have had the best patient outcomes ever. Our history tells us that fewer Victorians who suffered a cardiac arrest, stroke or other serious illness would be alive today had we not made these changes.”

Associate Professor Walker said the complex case code classifications being released was designed for a computer aided dispatch system used by 3000 ambulance services worldwide.

“The case code classification is part of a proprietary system and reflects the most severe injuries in that category. The names it uses do not always reflect the broad range of case types within that category.”

“We know that people who call Triple Zero (000) don’t always need an immediate lights and sirens response,” he said.

Experienced paramedics or registered nurses now ask a series of questions of less-urgent Triple Zero (000) callers to find out more information about an individual’s health issue and explore alternative options to emergency ambulance. This can include sending non-emergency transport, connecting patients with a doctor or pharmacist, or providing health advice to treat conditions safely at home.

“What is important to know is that in more than 90 per cent of calls to Triple Zero (000), an ambulance is dispatched,” Associate Professor Walker said.

In 2015, Ambulance Victoria undertook a comprehensive review of its dispatch grid – a database of more than 1000 classifications assigned to patients during Triple Zero (000) calls.

The review found 255 classifications that previously resulted in a Code 1 “lights and sirens” response were more suitable for a less-urgent ambulance response or more comprehensive triage by paramedics or registered nurses. A further 71 case types that previously automatically led to a Code 2 response (not lights and sirens) were suitable for further triage to provide patients the most appropriate response.

The revised Clinical Response Model was introduced over 12 months from October 2015, with each stage subjected to stringent assessment, trial, evaluation and rigorous clinical oversight.

As a result:

  • More Victorians are surviving cardiac arrest than ever before with ambulances reaching them in record time – an average response time of 7.7 minutes. Paramedics attended 6,034 cardiac arrest patients in 2016/17 – the most ever – and survival for patients in a shockable rhythm to hospital discharge was the highest ever at 34 per cent. In 2016/17, a record 379 patients were discharged alive from hospital – 21 more than the previous year.
  • The percentage of suspected stroke patients transported within an hour to specialist stroke facilities has climbed to 97.8 per cent in the final three months of 2017 compared with 87.9 per cent in the three months to September 2015.
  • 81.4 per cent of Code 1 ambulances are arriving within 15 minutes, compared with 74.6 per cent before the introduction of the new clinical response model.
  • Average response times for Code 2 patients have also improved to 26 minutes and 20 seconds compared with 30 minutes and 45 seconds.

“By not sending emergency ambulances Code 1 to patients who don’t need it, we have been able to improve our Code 1 response to the patients who do, and these patients are getting faster responses and better health outcomes,” Associate Professor Walker said.

The safety and wellbeing of patients is our priority and when people call Triple Zero (000) there are multiple safeguards built into how we assess individual requirements and prioritise urgent health needs.

“Victorians can be assured that they are getting a better response from their ambulance service as a result of these changes.”

Dispatch Grid Changes