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

Area of Science:

• Emergency medical services
• Healthcare system management
• Patient safety

Background:

• Dispatch centers (DCs) are crucial but costly components of healthcare systems.
• Historical distribution of DCs often doesn't align with modern technological capabilities.
• Technological advancements reduce the need for geographical proximity between DCs and populations.

Purpose of the Study:

• To evaluate the impact of merging two medical dispatch centers on quality and patient safety.
• To assess changes in triage performance, specifically over- and under-triage rates, post-merger.

Main Methods:

• Analyzed performance of two medical dispatch centers for 12 months pre- and post-merger.
• Measured triage accuracy by comparing dispatcher-assigned priority with on-site paramedic assessment using the National Advisory Committee for Aeronautics (NACA) score.
• Defined over-triage (lights & siren dispatch for low-severity cases) and under-triage (non-lights & siren dispatch for high-severity cases).

Main Results:

• Prior to merger, Dispatch A: 86% sensitivity/48% specificity, 78% over-triage, 5% under-triage. Dispatch B: 92% sensitivity/20% specificity, 84% over-triage, 7% under-triage.
• Post-merger, combined performance: 87% sensitivity/67% specificity, 71% over-triage, 3% under-triage.
• The merger led to a significant reduction in under-triage and a slight improvement in sensitivity and specificity.

Conclusions:

• Merging dispatch centers can enhance the quality of emergency medical services.
• Reductions in over- and under-triage improve patient safety and optimize the use of emergency resources.
• Mergers are particularly effective when a lower-performing center integrates with a higher-performing one.