Impact of two-level filtering organization on population's accessibility to an emergency medical communication centre

Emergency Medical Communication Centres (EMCCs) play a critical role in the timely coordination of out-of-hospital emergency responses. As demand for emergency services continues to rise, these centres face significant challenges in maintaining operational efficiency and service quality in order to provide a priority response to life-threatening emergencies. While the two-level answering system - i.e. a two-tiered response by call takers - has shown promise in simulation studies, its effectiveness in real-world settings has yet to be fully evaluated.

This study aimed to assess the impact of implementing a two-level answering system on service quality (rate of answered calls) at 30 s (QS30) across three EMCCs, marking the first evaluation of this system in everyday operations. We also investigated how variations in organizational structure among the EMCCs may influence QS30.

We conducted a multicentric, observational, retrospective study analyzing call data collected between May and June of 2022 and 2023, in France. Three EMCCs-35, 44, and 86-were included, with EMCCs 35 and 44 having implemented the two-level system, while EMCC 86 served as the control. Each EMCC employed distinct organizational models for the two-level system. Key performance indicators were assessed using non-parametric statistical tests, including the Wilcoxon and Kruskal-Wallis tests. Additionally, structural equation modeling was used to explore relationships between variables affecting service quality.

A total of 255,438 calls were analyzed, with 152,108 calls during the two-level period. The QS30 for EMCC 35 ranged from 93% in 2022 to 91% in 2023 (p < 1e-4), while EMCC 44 saw an increase from 91 to 100% (p < 1e-4). In contrast, EMCC 86 maintained a stable QS30 of 100%, with no significant change in activity (p = 0.1). Further analysis revealed significant differences in QS30 across the three EMCCs, suggesting that the distinct organizational structures of the two-level systems influence overall service quality. Structural equation modeling also highlighted strong correlations between call volume, agent workload, and QS30, emphasizing the impact of staffing and organizational structure on service quality.

The findings suggest that the two-level answering system may be effective in enhancing EMCC performance, particularly in managing increased call volumes. Additionally, the study highlights the potential importance of organizational differences in shaping QS30 outcomes. Future research should focus on longitudinal effects and explore innovative strategies to sustain high-quality EMCCs amidst evolving demands.