Resuscitation Plus (Jun 2021)
Assessment of a quality improvement programme to improve telephone dispatchers’ accuracy in identifying out-of-hospital cardiac arrest
Abstract
Introduction: Early recognition of out-of-hospital cardiac arrest (OHCA) by the medical dispatcher is a prerequisite for an effective chain of survival, leading to rapid dispatch of emergency medical services. Aim: To analyse and compare the accuracy of the Emergency Medical Dispatch Centre in identifying OHCA before and after an educational intervention. Methods: A quality-assessment study collecting data from prehospital medical voice logs in Southern Denmark during two periods. Baseline data and post-interventional data were obtained during December, January, and February 2017/2018 and 2019/2020, respectively. We imposed an intervention consisting of a specifically targeted education in quick assessment of OHCA and instructions regarding telephone-assisted-CPR.The primary outcome measure was the dispatcher's ability to recognise OHCA. Secondary outcome measures were time from contact with the caller to the dispatcher formulated essential questions related to the NO-NO-GO algorithm. These questions included an assessment of the patients’ consciousness and respiratory efforts and if both negative, would ideally lead to the dispatcher initiating telephone-assisted-CPR. All data was analysed in accordance with the recommendations and performance goals made by Resuscitation Academy. Results: Baseline data included 209 calls. Post-interventional data was based on 208 calls.The sensitivity for recognition of OHCA was 82.3% (95% CI: 76.4–87.2%) before and 92.7% (95% CI: 88.2–95.8%) after the intervention (p = 0.0014). The median duration of calls before recognition of OHCA was 68 and 56 s before and after the intervention (p = 0.097). Conclusion: After the period of intervention, the accuracy of OHCA recognition by dispatchers improved. The median time to identify OHCA or recognise the first compression did not differ significantly. This indicates that continuing education and quality assessment may be beneficial and necessary.
