ATRUST Teleguide Algorithms
The Teleguide nurse triage system includes a series of symptom-specific, gender-specific and age-specific, trinary logic algorithms which are used by call center nurses in non-emergent situations to interpret the symptoms of callers, and to direct these callers to an appropriate level of care or self-management. Each ATRUST Teleguide Algorithm features a logically structured question sequence that enables the nurse to assess the possibility that serious, emergent or life-threatening pathology may underlie the caller's symptoms. Should serious pathology be deemed possible, the appropriate Algorithm endpoints housed in PSIAM software are seamlessly transferred to PSIAM's embedded ProQA system along with information obtained during the call and the appropriate ProQA dispatch code is triggered. For symptoms that are determined to be benign and self-limited, the Teleguide Algorithms prompt call center nurses to provide endpoint specific interim management instructions, call back instructions, and follow-up phone calls as appropriate. In cases where symptoms are determined to represent a potential medical emergency.
Each ATRUST Teleguide Algorithm consists of an array of flow-control and logic pointers linked to clinical content containing triage questions and final end point instructions. The questions are dynamically personalized to the caller's demographics at run time to foster effective dialogue between caller and nurse. The ATRUST Teleguide Algorithms are IT platform independent in that all requisite algorithm flow and content instructions are maintained in the Teleguide triage system databases.
Algorithm content is further enhanced through linkage to algorithm-specific overviews, clinical rationales for each question in the sequence, and a reference list.
Since they are in fact algorithms as opposed to open-ended protocols, the ATRUST Teleguide Algorithms provide a reproducible, standardized approach to phone triage. The ATRUST Teleguide Algorithms provide call center nurses with a structured question sequence, and this eliminates unintended variation in the call, such as forgetting to ask a key question, not accounting for a caller's underlying illness, or the inadvertent introduction of bias into the call process. This approach minimizes malpractice risk and enables process improvement techniques and statistical analyses to be used in improving triage performance.
At the same time, the ATRUST Teleguide Algorithms foster an appropriate use of discretion by call center nurses. For example, there is an override switch which enables a nurse to select the disposition that he or she feels is the most appropriate given the circumstances of the individual call. In such cases, the system prompts the nurse to explain why the system’s suggested disposition was not invoked, and this becomes part of the call record. Nurses also have discretionary abilities to back-out of questions or entire algorithms, and to select self-care and call back instructions from a menu.
Medical Priority Dispatch System (MPDS) and ProQA
In the 30-plus years since it was introduced into emergency dispatch facilities around the world, the Medical Priority Dispatch System has become the undisputed international gold standard for pre-arrival instructions and dispatch life support protocols. For its part, ProQA is the delivery engine for MPDS. ProQA invokes a set of symptom-specific protocols to determine the health status of a person who has contacted an emergency access number. Based on this information, ProQA recommends an appropriate level of response, both in terms of type of ambulance to be dispatched and the speed with which it should respond. This non-linear response methodology establishes local response assignments to match each MPDS code (disposition) in terms of advanced life support (ALS)/basic life support (BLS) capability, hot/cold response (lights and siren) and multiple or single unit dispatch. The categories of response include Delta (ALS Hot), Charlie (ALS Cold), Bravo (BLS Hot), Alpha (BLS Cold) and the Omega tier which in PSIAM sets up automated transfers to Nurse advice in a seamless interface. Local medical control establishes the actual response configurations, regardless of these generic tiers. Further considerations are made as to length of response time and local emergency care facility locations.
Since the protocols, recommendations and pre-arrival instructions involve potentially life and death situations, they have for many years been subjected to rigorous medical review by an agency known as the International Academies of Emergency Dispatch. This group includes independent physicians and public safety experts who specialize in emergency medicine.
ProQA enables the call taker to rapidly and safely navigate through an MPDS protocol. In the manual protocol version of MPDS, the call taker must determine the appropriate response by gathering data during an interrogation process and deciding which determinant to choose based on that raw, unordered information. ProQA is an expert system, whereby the key questions and answers are pre-determined in logic to offer an appropriate response determinant. In addition, the manual protocol system allows for deviation to the protocol, and quality assurance techniques must be more stringent to measure compliance. ProQA, however, encourages compliance to protocol more effectively, thereby reducing the amount of time spent reviewing cases for compliance.
ProQA also features built-in reporting capability which facilitates assessments of the performance of individual staff, and the entire dispatch center. Such assessments include compliance with protocol, call processing time (EMD portion), and peer comparisons. ProQA also offers, through the export data facility, the ability of the PSIAM system to import data into other database structures in order to augment other statistical data gathered by other dispatch center tools.
ProQA is used to determine the incident code, via the standardised coding system as structured by the protocol. This enables each dispatch center to tailor the response to meet local medical control parameters and equipment availability. ProQA does not perform the functions of a Computer Aided Dispatch (CAD) system per se, but is a tool used by CAD in the determination of response allocation.