Abstract

ABSTRACT Introduction: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusion: 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.