Development of a Telephone Triage and Criteria-Based Dispatch System for Acute Ischemic Stroke Patients of the Emergency Medical Service Call Center, Phrae Province

Abstract

This study aimed to develop a telephone triage and task allocation system for patients with acute ischemic stroke at the in the Emergency Medical Dispatch Center, Phrae Province. The research process consisted of three steps: 1) analyzing the situation of stroke patient emergency calls over the past six months and conducting focus group discussions for in-depth data collection; 2) developing a telephone triage and dispatch system based on the findings from step one; and 3) testing the effectiveness of the developed system. The purposive sample included 11 personnel and 60 patients, and were assigned to control and experimental group.  Each group consisted of 30 participants. Data were collected before and after the use of the triage guidelines. General data of the sample groups were analyzed using descriptive statistics, while differences between the control and experimental groups were compared using dependent t-test, independent t-test and Wilcoxon Rank sum test.

The results showed that: 1) the accuracy of telephone triage for acute ischemic stroke patients was improved after the system development; 2) the developed triage and dispatch system demonstrated high reliability, with a Content Validity Index  of 0.98; 3) personnel knowledge was significantly increased after training (p < 0.01), and the rate of correct triage and dispatch was increased from 83.3% to 100% (p = 0.05); and 4) personnel satisfaction with the practice was at a very high level (mean = 4.71, SD = 0.44), with the increased rate of  the stroke fast-track access from 33.3% to 63.3% (p = 0.04) and the increased rate of the rt-PA administration from 3.3% to 10%, with an average door-to-needle time of 68 minutes.

Conclusion, the telephone triage and criteria-based dispatch system for acute ischemic stroke patients which has been developed in this study can be used at the emergency medical service center with a similar context to the research. It was suggested that there should be a training and communicate with the user to gain proper understandings before using this system.