Andy Heward, development officer with London Ambulance Service and currently working with Peter Bradley on the ambulance review, talks about how previous call categorisation audits have really contributed to delivering a more effective service, and appropriate care, to patients.
Since the introduction of call categorisation to the UK in 1996, some work has been done to ensure that calls are analysed and responded to appropriately, providing patients with the most appropriate care at the scene. A robust evidence base is really important in this process, enabling effective decision making. Although previously this has been fairly sporadic, there are some great examples, which show the vital contribution services can make in this process.
An early stipulation of call categorisation was that all patients under the age of two should receive a Category A, eight-minute response, regardless of clinical need. The aim was to ensure that no infant 'slipped through the net' and was under-triaged. The reality meant that ambulance services were dispatching fast response vehicles, responding with lights and sirens to babies with nappy rash and colic, among other complaints. This impacted on crews' perception of call categorisation as well as operational issues around finite resources regularly being tied up.
But for the issue to be addressed appropriately, a clear evidence base was needed. One service undertook a snapshot audit, looking at patients under the age of two and their respective complaints. This found there was little risk of infants in this age group being under-triaged if the process of a call categorisation was left to work on its own. The work was submitted to the Emergency Call Prioritisation Advisory Group (ECPAG) for consideration and, in 2004, the mandatory response for patients under two years was removed.
A similar piece of work was undertaken following feedback from crew staff regarding patients triaged as suffering from chest pain. Crews were finding that many patients were actually suffering from abdominal pain when they reached them. The underlying reason for this seemed to be the result of a call categorisation protocol for abdominal pain, which was the original complaint of a number of these patients. In this protocol, patients were being asked if they had chest pain and a large proportion answered yes, meaning they were triaged according to the latter pain.
A solution was subsequently identified through work with the call categorisation manufacturers and released in later versions. Follow-up work has shown that the number of callers triaged as having chest pain has dropped by 20 per cent.
Here we can see how important it is that improvements to service delivery are user-led and evidence-based. Services themselves are vital in influencing this change.
