Table 1 Possible interventions
Regional considerations | Decision-making and prioritization | ||||||||
|---|---|---|---|---|---|---|---|---|---|
Possible interventions: their implementation and effect | Best intervention variables (BIVs) | ||||||||
Intervention | Description and impact on rising EMS demand | Predicted implementation difficultya | Predicted effecta | Directly connected BIVs | Active sum* | Produced delay** | Connection to key issue | Delay to key issue | |
A. Nonurgent medical transport portal | This electronic portal would be used to schedule (nonemergency) patient transports. Hospitals and dispatch centres would have access to the overview to schedule transport. This leads to improved discharge management due to simplified processes and more timely allocation of transport. This could enhance resource allocation and planning and thus counteract rising EMS demand. |
|
| 36 EMS resources | 3.0 | 1.0 | 38 ➔ 36 ➔ n ➔ 22 | ++ | |
B. Standardized structured triage tool (dispatch centre) | A standardized structured triage tool will allow for more standardized and structured dispatching processes. Patients could be directly referred to the right (emergency) medical service. The appropriate urgency level and resources could be dispatched. This would decrease unnecessary transport and counteract rising EMS demand. |
|
| 9 Nonemergency cases | 5.0 | 1.4 | 39 ➔ 9 ➔ 22 | + | |
C. Community paramedic | A community paramedic is most commonly dispatched in cases where it is clear that it is not an emergency, but the situation on-site and the kind of help needed is rather unclear or low-acuity. The community paramedic should be able to refer the patient to a hospital or other (medical) services. This would thus counteract rising EMS demand. |
|
| 9 Nonemergency cases | 5.0 | 1,4 | 40 ➔ 9 ➔ 22 | + | |
36 EMS resources | 3.0 | 1.0 | 40 ➔ 36 ➔ n ➔ 22 | ++ | |||||
37 Alternative services (dispatch centre) | 3.0 | 1.3 | 40 ➔ 37 ➔ 9 ➔ 22 | +b | |||||
- aPredicted by the workshop participants;
easy,
rather easy,
very difficult,
moderately high effect,
rather high effect,
high effect; * min. 1.0, max. 8.0 active sum; ** min. 1.0, max. 3.5 produced delay; + = no delay (immediate effect); ++ = delay occurs; n = continuation of path over various variables - bOverall delay (the changes happen one after the other)
easy,
rather easy,
very difficult,
moderately high effect,
rather high effect,
high effect; * min. 1.0, max. 8.0 active sum; ** min. 1.0, max. 3.5 produced delay; + = no delay (immediate effect); ++ = delay occurs; n = continuation of path over various variables