Is emergency medical dispatcher low-acuity code selection influenced by a user-interface software modification?

ABSTRACT

Sick Person (Specific Diagnosis) is one of the most commonly used Chief Complaint Protocols in the Medical Priority Dispatch System™. Within the Sick Person Protocol, the 26-A-1 coding represents a group of patients with no specific identifiable complaint. This vague categorization presents a problem for dispatch systems and EMS responders alike, since so little is captured about the patient’s true condition.

The objective of this study was to determine whether changing the order of the “No” answer choice on the single Key Question, “Is ‘primary problem’ one of the listed ALPHA-level NON-PRIORITY complaints (2-12)?” would lower the frequency of selecting “No,” along with the corresponding 26-A-1 final coding, and increase the frequency of selecting one of the other, more specific ALPHA- or OMEGA-level conditions.

This was a retrospective and prospective, non-randomized, observational study conducted at two IAED™ Accredited Centers of Excellence (ACEs) in the USA. For the control phase, the EMDs continued to use the existing MPDS® software system. For the intervention phase, a study protocol was developed that integrated two modifications into the ProQA® software: An answer choice was moved within a drop-down list and a dialog “comment” box was added.

The percentage of ALPHA-level calls coded as 26-A-1 decreased significantly following the intervention (13.2% before and 9.3% after; p < 0.001). The amount of the decrease varied by study site. The overall frequency of ALPHA-level codes increased, while the frequency of OMEGA-level codes decreased. Some specific ALPHA-level codes, such as 26-A-2, increased following the intervention.

While it might not completely eliminate default selection and “work-arounds,” a permanent change to the software, matching the modifications made for the intervention phase of this study, would be a first step to improving accuracy in selecting codes for this protocol.

CITATION

Scott, G., Olola, C., Gardett, I., Broadbent, M., Sangaraju, L., Schultz, B., Burnette, L., & Clawson, J. (2018). Is emergency medical dispatcher low-acuity code selection influenced by a user-interface software modification? Annals of Emergency Dispatch and Response, 6(2), 11-16.

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