Background Following the introduction of electronic patient clinical records, ambulance service managers wished to combine clinical and operational data to devise a method of risk stratifying 999 calls by the MPDS disposition code assigned at call triage. Initial aims were to establish the risk threshold if an ambulance was no longer routinely dispatched.
Methods Data selected were representative of high or low clinical risk, and reliably recorded. The following ‘risk factors’ were chosen:
With expert local opinion, a scoring algorithm was created using weighted factor scores to create an aggregate risk score for each MPDS code. It was also designed to distribute codes along a ‘risk range’, allowing for thresholds setting suitable to the specific purpose of individual projects. These factors and their scores were captured alongside contextual information and to date contains over 1.4 million records over 3 years.
In collaboration with academic colleagues, we also developed an AI model to refine the algorithm used to reflect acuity. With one year of data the tool did not demonstrate the sensitivity or specificity to reliably contribute to prediction, however this exercise may be repeated now there is a greater volume of data.
Applications: This Tool has been successfully used for a variety of purposes:
Developing the Enhanced Hear and Treat policy
Assessing risk of code downgrades in the pandemic response
Identifying codes suitable for automatic specialist clinician allocations
Supplementing analysis of harm caused by long response delays
Identifying codes for protection within End of Shift protocols
Providing intelligence to aid national decisions on code categorisation
Next steps: The Tool continues to assist in decision-making locally. Future ambitions include:
Validation of the scoring algorithms
Process automation to ensure more timely data is available
Collaboration to improve the variety and volume of data
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.