Identifying Optimization Targets in 911 Dispatch Workflows for Out-of-Hospital Cardiac Arrest Management.
Document Type
Conference Proceeding - Restricted Access
Publication Date
11-17-2020
Publication Title
Circulation
Abstract
Introduction: Dispatch processes for prehospital management of out-of-hospital cardiac arrest (OHCA) vary greatly by region, and so do the barriers and facilitators of rapid time-to-first-treatment within those systems. In order to optimize local OHCA response, we sought to identify improvement targets by tracking time intervals during OHCA 911 calls and evaluating associated barriers and facilitators to timely OHCA prehospital care delivery.
Methods: We developed a data abstraction tool to collect quantitative and qualitative data regarding key events in a random sample of 23 of emergency medical services (EMS)-confirmed, second-party, non-traumatic, non-overdose, non-facility adult OHCAs occurring prior to first responder arrival from November 2017 to November 2019 in Washtenaw County, Michigan. Trained abstractors double reviewed calls. We calculated descriptive statistics of key event times to summarize a timeline of care and evaluated qualitative data using thematic analysis to assess event intervals.
Results: Based on quantitative and qualitative analyses, we created a timeline with summary data of dispatcher OHCA response based on an aggregate of 23 calls to 911 dispatch (see Figure 1). Data abstractors identified two intervals-of-interest as containing barriers to optimizing time-to-first treatment: 1) time between the first report of abnormal breathing and call taker statement of CPR need (Interval 1), and 2) time from patient positioning to the first compression instruction (Interval 2). Qualitative data suggested that these interval delays were a result of extensive efforts on the part of the call taker to reconfirm breathing status in particular. Additional barriers, such as the callers misunderstanding instruction, and on-scene physical limitations, were also identified.
Conclusions: We identified two primary time intervals to target for improvement as well as barriers present in our local 911 system. These data may serve as a foundation to develop targeted interventions to optimize local systems of care for 911 dispatch workflows.
Introduction: Dispatch processes for prehospital management of out-of-hospital cardiac arrest (OHCA) vary greatly by region, and so do the barriers and facilitators of rapid time-to-first-treatment within those systems. In order to optimize local OHCA response, we sought to identify improvement targets by tracking time intervals during OHCA 911 calls and evaluating associated barriers and facilitators to timely OHCA prehospital care delivery.
Methods: We developed a data abstraction tool to collect quantitative and qualitative data regarding key events in a random sample of 23 of emergency medical services (EMS)-confirmed, second-party, non-traumatic, non-overdose, non-facility adult OHCAs occurring prior to first responder arrival from November 2017 to November 2019 in Washtenaw County, Michigan. Trained abstractors double reviewed calls. We calculated descriptive statistics of key event times to summarize a timeline of care and evaluated qualitative data using thematic analysis to assess event intervals.
Results: Based on quantitative and qualitative analyses, we created a timeline with summary data of dispatcher OHCA response based on an aggregate of 23 calls to 911 dispatch (see Figure 1). Data abstractors identified two intervals-of-interest as containing barriers to optimizing time-to-first treatment: 1) time between the first report of abnormal breathing and call taker statement of CPR need (Interval 1), and 2) time from patient positioning to the first compression instruction (Interval 2). Qualitative data suggested that these interval delays were a result of extensive efforts on the part of the call taker to reconfirm breathing status in particular. Additional barriers, such as the callers misunderstanding instruction, and on-scene physical limitations, were also identified.
Conclusions: We identified two primary time intervals to target for improvement as well as barriers present in our local 911 system. These data may serve as a foundation to develop targeted interventions to optimize local systems of care for 911 dispatch workflows.
Volume
142
Issue
suppl 4
First Page
A297
Recommended Citation
Sams W, Dowker S, Trumpower B, O'Leary M, Kamdar N, Smith GC, Hunt NR, et al. Identifying optimization targets in 911 dispatch workflows for out-of-hospital cardiac arrest management. Circulation. 2020;142(suppl 4):A297.
DOI
10.1161/circ.142.suppl_4.297
Comments
Resuscitation Science Symposium, Virtual, November 14-16, 2020.