Overtriage of a physician-staffed prehospital emergency resource in Austria : An exploratory retrospective analysis

Appropriate emergency medical dispatch aims to balance rapid deployment of physician-staffed emergency medical services against unnecessary utilization of limited prehospital resources. Data on physician dispatch appropriateness in Austrian emergency medical services remain scarce. This study evaluated overtriage of a physician-staffed emergency medical response vehicle in Lower Austria.

This single-center retrospective study included all primary dispatches of a physician-staffed emergency medical response vehicle between January and December 2022. Dispatches were retrospectively classified as appropriately triaged or overtriaged based on predefined criteria. Secondary objectives were overtriage across the 10 most frequent dispatch codes and the association between priority level and dispatch appropriateness.

Overall, 3454 primary dispatches were analyzed and 2629 dispatches were classified as overtriage (76.1%; 95% confidence interval, CI 74.7-77.5%). Of these, 38.4% represented dispatches without patient contact and 37.7% were classified as low acuity overtriage, while only 23.9% (95% CI 22.5-25.3%) were retrospectively classified as appropriately triaged. The 10 most frequent dispatch codes accounted for 41.8% of all dispatches and demonstrated a combined overtriage rate of 77.1% (95% CI 74.8-79.2%). Priority level was not associated with physician dispatch appropriateness (ρ = -0.002, p = 0.92).

In this study, over three quarters of physician-staffed emergency medical service dispatches did not meet the predefined retrospective criteria for physician involvement, although about half of these overtriaged cases were cancelled before physician-patient contact. Among cases with patient contact, 61% did not meet the predefined criteria for physician-level care. These findings highlight substantial potential to refine emergency physician-dispatch criteria.