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Re: "non-serious" 999 ambulance service callers

Dear Editor

Management of non-serious 999 calls by nurse-led telephone triage and advice or referral: building on initial research

The Editors’ response to Dale et al.’s paper [1] rightly highlights the need for further research to evaluate the safety, appropriateness and effectiveness of the management of some non-serious 999 calls with telephone advice only.

At the time of the ‘Telephone Advice study’ that was undertaken in London and the West Midlands Ambulance Services, NHS Direct did not exist and the Reforming Emergency Care agenda was in its infancy. Developments since then have only served to reinforce the importance and relevance of this initial work, as well as providing a further context and opportunity to take this research forward. Most recently, the Department of Health has in “Developing NHS Direct” [2] clearly set out a target for the management of some low priority 999 calls by NHS Direct.

We have now secured funding to carry out a collaborative project between the Universities of Sheffield and Swansea and in three ambulance and corresponding NHS Direct Sites (Wales, Manchester and Thames Valley) to evaluate the management of non-serious 999 calls with either self care or referral to alternative healthcare following nurse-led telephone triage. This two-year study is being funded by the Department of Health Service Delivery and Organisation (SDO) Research Programme starting in April 2003.

The study is being undertaken in three phases:

1. Identification of appropriate ambulance service dispatch codes for transfer to NHS Direct for further triage
2. A randomised controlled trial of passing calls within the designated codes to NHS Direct nurses for further triage and subsequent self-care advice or referral to alternative care agencies
3. Full testing of capacity, resource and operational consequences for the ambulance service and NHS Direct of implementing the new service

Outcomes to be measured include:

• processes of care


• how many calls are passed back to the 999 service following assessment by NHS Direct?


• What time delays do patients experience


• clinical safety


• patient satisfaction


• resource usage


• operational impact – improvement in 999 response times for life- threatening calls, decrease in inappropriate ambulance admissions to A&E, and staffing requirements for NHS Direct

Providing appropriate care for 999 callers is a key aspect of the Reforming Emergency Care programme. Telephone triage, advice or referral provided by NHS Direct seems to offer a sensible and efficient alternative, but will depend on the triage systems being compatible and capacity being available. As the EMJ Editors point out, identifying non- serious 999 calls at the point of the call being made is not simple, and not all non-serious calls are suitable for telephone advice. Older people who fall, for instance, may not need an immediate, ‘lights and sirens’ response – but telephone advice will not help them off the floor either. Only robust, well-designed research can answer the questions that surround the tempting alternative of NHS Direct management of some 999 calls. We hope that this study will provide these answers and look forward to sharing our results at the end of the research.

Helen Snooks
Janette Turner
Malcolm Woollard
on behalf of the project team.

References

(1) J Dale, J Higgins, S Williams, T Foster, H Snooks, R Crouch, C Hartley-Sharpe, E Glucksman, R Hooper, S George. Computer assisted assessment and advice for “non-serious” 999 ambulance service callers: the potential impact on ambulance despatch. Emerg Med J 2003; 20:178-183.