Merger of two dispatch centres: does it improve quality and patient safety?

BACKGROUND: Dispatch centres (DCs) are considered an essential but expensive component of many highly developed healthcare systems. The number of DCs in a country, region, or state is usually based on local history and often related to highly decentralised healthcare systems. Today, current technology (Global Positioning System or Internet access) abolishes the need for closeness between DCs and the population. Switzerland went from 22 DCs in 2006 to 17 today. This study describes from a quality and patient safety point of view the merger of two DCs. METHODS: The study analysed the performance (over and under-triage) of two medical DCs for 12 months prior to merging and for 12 months again after the merger in 2015. Performance was measured comparing the priority level chosen by dispatcher and the severity of cases assessed by paramedics on site using the National Advisory Committee for Aeronautics (NACA) score. We ruled that NACA score > 3 (injuries/diseases which can possibly lead to deterioration of vital signs) to 7 (lethal injuries/diseases) should require a priority dispatch with lights and siren (L&S). While NACA score < 4 should require a priority dispatch without L&S. Over-triage was defined as the proportion of L&S dispatches with a NACA score < 4, and under-triage as the proportion of dispatches without L&S with a NACA > 3. RESULTS: Prior to merging, Dispatch A had a sensitivity/specificity regarding the use of lights and sirens and severity of cases of 86%/48% with over- and under-triage rates of 78% and 5%, respectively. Dispatch B had sensitivity and specificity of 92%/20% and over- and under-triage rates of 84% and 7%, respectively. After they merged, global sensitivity/specificity reached 87%/67%, and over- and under-triage rates were 71% and 3%, respectively CONCLUSIONS: A part the potential cost advantage achieved by the merger of two DCs, it can improve the quality of services to the population, reducing over- and under-triage and the use of lights and sirens and therefore, the risk of accidents. This is especially the case when a DC with poor triage performance merges with a high-performing DC.

[Non invasive ventilation in the emergency setting]. / Ventilation non invasive en urgence.

Before the development of non invasive ventilation (NIV), endotracheal intubation was the only ventilatory therapy available in case of severe respiratory distress and acute respiratory failure. NIV used to be employed in intensive care settings only. Nowadays, the use of NIV has been democratized to include the emergency room, and the pre-hospital care setting for treatment of acute respiratory failure. Cardiogenic pulmonary edema and acute exacerbation of COPD are indications of choice, since NIV improves mortality. The efficiency of the therapy depends on early treatment; however, endotracheal intubation should not be delayed when it becomes necessary.

[When should a patient with malaise be referred to the emergency ward?]. / Quand référer aux urgences un patient présentant un malaise?

General physicians (GPs) and emergency doctors are regularly called upon to deal with cases of "malaise" or sudden unforeseen feelings of debility. As highly disparaged as this designation may be, it remains commonly used in everyday life, enabling patients to express a general sensation of ill-being, accompanied by various non-specific symptoms. The lack of a preliminary case history and clinical analysis makes difficult to swiftly determine the severity of the situation, let alone its etiology. GPs are expected to rapidly detect any possibly serious risk factors; the decision to either hospitalize the patient or allow him to return home, is in their hands. The following article sets forth algorithms to assist with the diagnostic process and general handling of such cases.

[Patient waiting time at the Medical and Surgical Emergency Center at the Hôpital des Cadolles: a descriptive study]. / Enquête sur tes délais d'attente au Centre médico-chirurgical d'urgences, Hôpital des Cadolles, Neuchâtel.

Analyzing how much time patient are waiting in the Medical and Surgical Emergency Center (Centre médico-chirurgical des urgences, CMCU) at the Hôpital des Cadolles (Neuchâtel, Switzerland) before discharge, over a 80 days period found that overall, patients spent on average 2 h 26 in the CMCU. There was a difference between hospitalized patients (3 h 16) and discharged patients (1 h 48). The time from first encounter with a health care provider until discharge or admission was 1 h 42 on average. Again, this time was longer for hospitalized (2 h 15 versus 1 h 17 for ambulatory patients). The majority of patients (76%) were assessed by a nurse or a physician within 5 minutes, while the other 24% of patients had to wait 15 minutes on average. Specifically, 26% of patients were seen by a physician within 5 minutes, while the other 74% had to wait 26 minutes on average.

[Health care organization at the time of a mass event. The example of EXPO 02--Neuchatel]. / Organisation sanitaire lors d'une manifestation de masse. Exemple d'EXPO 02--Neuchâtel.

The last National Exhibition "EXPO 02" took place in Switzerland in 2002. More than 10 million people visited in within 159 days. The medical service and the "first aid" structures took pattern from other similar events in Switzerland or abroad. EXPO 02 was held on 4 sites. Our experience turned out interesting and somewhat different from the others sites because of the setting up of a "triage and coordination area" in the site of Neuchâtel.