Quality of Incoming Call Handling in an Emergency Dispatch Center (CRRAQPA)

Evaluation of the Quality of Incoming Call Handling Assisted by the proQA Software in the Emergency Dispatch Center of Besançon.

The aim of Emergency Medical Dispatch (EMD) is to ensure prompt access to medical care for all at all times, initiate appropriate responses quickly, arrange suitable hospital facilities, and coordinate patient transport and hospitalization.

In France, care begins with an incoming call managed by the EM Dispatchers, who collect the patient's details and assess the seriousness of the situation. This severity assessment is essential for triggering the appropriate resources: direct dispatch of first-aiders in extreme emergencies, or transfer of the call to an emergency or general practitioner.

Under- or over-assessment will necessitate redirection, resulting in a loss of time and opportunity for the patient, or emergency channel congestion. Errors at this stage can impact the entire care pathway.

To assist EM dispatchers, aids have been developed. Firstly, In France, a diploma course was created in 2019. Various training methods exist. Their contribution to the quality of incoming calls handling remains unevaluated. Secondly, EM centers use regulation protocols designed to guide dispatchers in call handling and identifying the seriousness of the situation.

The regulation protocol used at Besançon University Hospital is ProQA (Priority Dispatch Corporation, Salt Lake City, UT, US). It uses standardized questions and records EM Dispatchers' decisions and the responses they obtain from callers. These responses are considered by ProQA, which then assigns a "severity" code to the call.

The assistance provided by regulation protocols, however useful, remains insufficient. Contextual factors can complicate compliance with regulation protocols, making matching resources to needs challenging.

AQUA is a software package dedicated to quality control, enabling EM Dispatcher's supervisors to rate the quality of all stages of the call-taking process. This ensures that all key questions have been asked and that they have been asked correctly. In addition, the 'severity' code obtained by the EM Dispatcher can be compared with the 'severity' code obtained by the supervisor, using a qualifying analysis method and data entry software. The calls are replayed under optimal conditions, in a calm environment and allowing supervisors to listen multiple times to ensure no information is missed. the supervisors' code is therefore the reference code.

CRRAQPA study's aim is to assess the quality of incoming call handling and to identify the factors that influence this quality.

Study Overview

• Status: Recruiting
• Conditions: Medical Emergencies

• Study Type: Observational
• Enrollment (Estimated): 800

Contacts and Locations

• Study Contact: Name: Antoine Leclerc; Phone Number: +33 3 81 66 88 67; Email: aleclerc@chu-besancon.fr
• Study Contact Backup: Name: Jean-Baptiste Pretalli, PhD; Phone Number: +33 3 81 21 81 27; Email: jbpretalli@chu-besancon.fr

Study Locations

• France
  • Franche Comté
    • Besançon, Franche Comté, France, 25000
      • Recruiting
      • University Hospital of Besancon
      • Contact: Jean-Baptiste Pretalli, PhD; Phone Number: 33 3 81 21 81 27; Email: jbpretalli@chu-besancon.fr
      • Contact: Antoine Leclerc; Email: aleclerc@chu-besancon.fr
    • Besançon, Franche Comté, France, 25000
      • Recruiting
      • CENTRE HOSPITALIER UNIVERSITAIRE de BESANCON
      • Contact: Jean-Baptiste Pretalli, PhD; Phone Number: 33 3 81 21 81 27; Email: jbpretalli@chu-besancon.fr
      • Contact: Antoine Leclerc; Email: aleclerc@chu-besancon.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

We will study incoming calls in the EMD of Besançon University Hospital. These calls must be handled by a professional EM dispatcher and must have a 'severity' code that is not unfounded.

During the replay and evaluation, it can happen that the supervisor is unable to assign a severity code with certainty. This occurs when a decisive question regarding the severity code has not been asked, and the information has not been provided spontaneously by the caller. In such cases, the supervisor considers the code obtained by the EMD to be unfounded

Description

Inclusion Criteria:

• Calls handled by a professional EM Dispatcher during the study period.

Exclusion Criteria:

• Calls handled by a medical student functioning as an EM Dispatcher.
• Calls for which the "severity" code is unfounded.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The proportion of incoming calls for which the 'severity' code identified by the EM dispatchers during the call and the 'severity' code identified by the supervisor after replaying the call are in agreement.	The quality of the incoming call will be assessed based on the agreement between the 'severity' code identified by the EM dispatchers during the call and the 'severity' code identified by the supervisor after replaying the call using the AQUA software. There are six possible severity codes, which will be grouped into a three-category variables corresponding to the three possible referrals (emergency physician, general practitioner, 'flash' departure).	Through study completion, the anticipated duration is 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The proportion of over- and under-rated calls.	An over-rated call occurs when the severity level identified by the EM dispatcher is higher than that identified by the supervisor upon replay. An under-rated call occurs when the severity level identified by the EM dispatcher is lower than that identified by the supervisor upon replay	Through study completion, the anticipated duration is 1 year
The proportion of the different training modalities received by EM dispatchers.	In France, several training modalities exist for EM dispatchers such as field training, 2019 diploma training, training via tape replay, call simulation training.	Through study completion, the anticipated duration is 1 year
The number of years of experience in the profession of the EM dispatchers participating in the study.		Through study completion, the anticipated duration is 1 year
The rate of answered calls within 20 s (= quality of service at 20 seconds, QS20)		Through study completion, the anticipated duration is 1 year
The number of calls per hour in the call centre.		Through study completion, the anticipated duration is 1 year
The duration between the beginning of the EM dispatcher's shift and the time at which the incoming call occurs		Through study completion, the anticipated duration is 1 year
The proportion of incoming calls occurring during the day or night		Through study completion, the anticipated duration is 1 year
The proportion of incoming call occuring during week days or week-ends		Through study completion, the anticipated duration is 1 year

Collaborators and Investigators

• Sponsor: Centre Hospitalier Universitaire de Besancon
• Investigators: Principal Investigator: Antoine Leclerc, University Hospital of Besancon

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2024
• Primary Completion (Estimated): July 1, 2025
• Study Completion (Estimated): July 1, 2025

Study Registration Dates

• First Submitted: July 1, 2024
• First Submitted That Met QC Criteria: July 15, 2024
• First Posted (Actual): July 16, 2024

Study Record Updates

• Last Update Posted (Estimated): November 7, 2024
• Last Update Submitted That Met QC Criteria: November 6, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 2023/833

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The data in this study are not publicly available, but reasonable requests can be made.
• IPD Sharing Time Frame: Immediately following publication. No end date
• IPD Sharing Access Criteria: Researchers who submit a methodologically sound proposal approved by our research team
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No