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EENA2019: Track2 session5 _The evidence-based system for emergency triage_Christian Laucher


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The use of structured protocols in emergency call centres is widely recognised as an essential tool and critical to achieving a quality-centric organisation. In this session, you will hear from experts who have implemented structured protocols and the benefits that this has brought.

Chair: Demetrios Pyrros, President, EENA

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EENA2019: Track2 session5 _The evidence-based system for emergency triage_Christian Laucher

  1. 1. © 1977-2018 IAED The Evidence Base for the AMPDS Advanced Medical Priority Dispatch System
  2. 2. © 1977-2018 IAED | 2 Christian Laucher Notruf Niederösterreich Head of Process Management email: fulltime employment 1999 start working in a Emergency Center in Tirol 2001 start working with the EMD Protocol 2008 change to Notruf Niederösterreich 2009 Accredited Center of Excellence 2015 EENA Certificate of Quality Standard 112 … - a lot of changes and innovations - ReAccreditations, -certifications, Dispatchers of the year part time job 2004 start working for Priority Dispatch (PDC) 2006 my first Protocol Implementations for PDC in a Center 2008 First European Navigator in Berlin … - Teaching Medical, Police, QM - Implementations - Consulting
  3. 3. The Evidence base for the Advanced Medical Priority Dispatch System (AMPDS) The protocol himself Evidence Based Practice How changes migrate to the protocol Proposal for Change Clinical Expertise Examples 1 2 3 4
  4. 4. © 1977-2018 IAED | 4 The protocol himself
  5. 5. © 1977-2018 IAED | 5 What is Evidence-Based Practice? 1) EBM Evidence Based Practice Matters 1
  6. 6. © 1977-2018 IAED | 6 AMPDS Protocol Evolution as Evidence-Based Practice PFCs1 Councils of Standards Expert Opinion Practitioner-Engaged Research Published Research Continuous Data Analysis Council of Research University/IAED2 Partnerships Community-Engaged Research EMD3 Training 1) PFC Proposal for Change 2) IAED International Academies of Emergency Dispatch 3) EMD Emergency Medical Dispatch 4) EBM Evidence Based Practice Matters 4
  7. 7. © 1977-2018 IAED | 7 Proposal for Change (PFC) every center who use the protocol can submit a change • „Readers of the Council“ • subcommittee reviews and evaluates all PFC’s • formulate the finaly proposals • forwards Proposals to Voting Council • commission research or request clinical data, ... before a new version is coming … • „Cultural Meeting“ • in every language a group of users verify the protocol again, so that it works for this language
  8. 8. © 1977-2018 IAED | 8 Why Evidence-Based Practice Matters • Improves patient care and reduces unnecessary errors/negative outcomes • Reassures practitioner, patient, and family members that the best care was provided, even if outcome is negative • Increases community and patient confidence in care providers when they know EBP1 is being applied • Practitioners/clinicians feel more prepared for situations—more confidence and less stress • Reproducible care and reduced bias: all callers receive the same standard of care 1) EBP Evidence Based Practice
  9. 9. © 1977-2018 IAED | 9 Best Research Evidence: Examples
  10. 10. © 1977-2018 IAED | 10 Individual Clinical Expertise: Examples Aspirin (ASA Diagnostic Tool and Instructions): • Input from George M. Rodgers, MD, PhD, Professor of Medicine at University of Utah, on differences between Aspirin and blood thinners • Tool developed in collaboration with Joseph Ornato, MD, FACP, FACC, FACEP; Chairman of Dept. of Emergency Medicine at Virginia Commonwealth U and Medical Director of Richmond Ambulance Authority Not Alert (in progress) • Practitioner/clinicial (EMD and Medical Director) input has to led to the development of three studies with international scope (Brazil, Australia, UK, USA, involved) • Testing varied phrasings of “not alert” to determine is most accurate • Individual EMD input/evaluation is a key metric in at least one of the studies, along with hospital/EMS outcomes
  11. 11. © 1977-2018 IAED | 11 Individual Clinical Expertise: Practitioner-Engaged Research Practitioner-Engaged Research assumes that individual professionals (in this case, EMDs) have clinical and hands-on knowledge that is important to generating and making sense of research findings. To increase practitioner-engaged research in EMD, the IAED is running an annual research workshop (soon to be online and available for international attendees!) Three practitioner (EMD/EMD-Q) studies already published from it:
  12. 12. © 1977-2018 IAED | 12 Patient Values and Expectations: Examples Ongoing study: Caller Expectations of Emergency Dispatch in Diverse Communities • Focus group methodology • Working with 6 different communities in Utah—including Pacific Islander, American Indian, Hispanic, refugee (mostly African), African American, and LGBTQ • Better understanding their expectations, needs, and values, as well as their experiences calling for emergency services and their barriers to calling • Creating training for EMDs and may integrate some of the findings into protocol to reflect the needs of communities we serve • Developing a toolkit so others can do similar studies in their own communities
  13. 13. © 1977-2018 IAED | 13 Recommendations • First of all, use a protocol, because you should never forget anything – you only have one change to make it right • Do not make mistakes again that have already been discovered and eliminated somewhere in the world • Pay attention to which workgroups working behind a protocol, to make sure that it is not a one man show • Use an Evidence Based Protocol, because this is the only way to do the really right things
  14. 14. © 1977-2018 IAED | 14 Conclusions and Recommendations • The MPDS absolutely meets all three elements of the definition of evidence-based practice • EBP makes the protocol not only the standard of care, but gives both EMDs and our communities faith in the service they are being provided • The IAED continues to deepen our work in all three areas of EBP and will continue to publish and report on our findings