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Re: Is it the call that needs refinement of the system? NHS Direct

Dear Editor

Regarding the article by O’Cathain et al. [1] it was interesting to note the conflicting statements made towards the end of the paper.

The systems of NHS Direct were identified as having poor sensitivity and specificity when dealing with the studied calls, yet at the end the paper it states that the types of low priority calls referred need refinement due to at least one-fifth may be passed back to the ambulance service. My interpretation the findings are that calls are referred back to the ambulance service as not being suitable for telephone advice and/or treatment but as the sensitivity and specificity are so low, surely it is the NHSD systems that need investigating and refining!!

Also the paper makes no reference to the type of priority dispatch in use to identify the original calls. Criteria Based Dispatch is a semi- structured system with call-takers having the opportunity to be flexible in the triage of the patient ( and has been shown to be potentially risky) and AMPDS is a structured, rigid process where compliance to the system impacts the accuracy of detection. Without an explanation of which of these systems was in use and, if AMPDS, the compliance - the use of calls "triaged by priority dispatch as low priority" is meaningless because is it the system being measured or is the call-taker?

Reference

(1) A O’Cathain, E Webber, J Nicholl, J Munro, and E Knowles. NHS Direct: consistency of triage outcomes. Emerg Med J 2003; 20:289-292.