Revision of the Protocol of the Telephone Triage System in Tokyo, Japan.

Atsushi Sakurai,Jun Oda,Takashi Muguruma,Shiei Kim,Sachiko Ohta,Naoto Morimura,Takeru Abe,Yan-Ren Lin

doi:10.1155/2021/8832192

Abstract

Introduction The Emergency Telephone Consultation Center in Tokyo (#7119) was the first telephone triage system in Japan and has operated since 2007. This study examined the revision of the #7119 protocol by referring the linked data to each code of the triage protocol. Methods We selected candidates based on the medical codes targeted by the revision, linking data from the nurses' decisions in triage and the patients' condition severity when the ambulance arrived at the hospital, gathering data from June 1, 2016, to December 31, 2017. Then, several emergency physicians evaluated the cases and decided whether the code should be moved to the more or less urgent category or if new protocols and codes would be established. Results In this revision, 371 codes were moved to the less urgent category, 35 codes were moved to the more urgent category, and 128 codes were newly established. In all, 59 red codes (transfer to the ambulance dispatcher) were reduced, while 254 orange codes (attendance at hospital within 1 hour) and yellow codes (within 6 hours) were moved to less urgent, and 12 yellow and green codes (within 24 hours) were moved to more urgent. Conclusion We adjusted the triage codes for the revision by linking the call data with the case data. This revision should decrease the inappropriate use of ambulances and reduce the primary care workload. To achieve a more accurate revision, we need to refine the process of evaluating the validity of patients' acuity over the telephone during triage.

Highlights

In Japan, the number of patients transported to the hospital by ambulance is rising every year
Before the establishment of the #7119 center, an ambulance was definitely dispatched if an emergency call was received as there was no call triage system at the dispatcher in Tokyo’s ambulance system. e #7119 center was the first telephone triage system in Japan, serving a population of about 13 million citizens and operating computer-programmed medical protocols by the Emergency Telephone Consultation Center of the Committee of Emergency Medicine in the Tokyo Medical Association
We retrospectively reviewed the data of the Tokyo Fire Department (FD) from June 1, 2016, to December 31, 2017

Summary

Introduction

In Japan, the number of patients transported to the hospital by ambulance is rising every year. Inappropriate use of unnecessary emergency ambulance transfers is common [2] To solve this problem, many countries, including Sweden [3], Australia [4], the United Kingdom [5], and the United States [6], have established telephone-based medical consultation services. Is administrative guideline enabled us to acquire data on patients’ condition severity for all patients transferred to the hospital by ambulance Some of these cases were not assigned to the red category by the #7119 protocol but were ranked up to the red category by nurses (with the agreement of a physician) and transferred to the hospital by ambulance. Each code was linked with data on the total number of cases, rank-downs by nurses, transfers to the dispatcher, and patients’ condition (dead, lethal, severe, moderate, or mild). New symptoms or codes were established based on this conference

Results

Discussion

Findings

Conclusion