Introduction: The Yorkshire Ambulance Service (YAS) moved to Performance Standards 9 in November 2012. As a Trust aspiring for Accreditation, the Quality Audit Team (consisting of Emergency Dispatch Quality Assurance ED-Q specialists) wanted to ensure that compliance was suitably above the targets set by the International Academies of Emergency Dispatch (IAED). The goal of this study was to improve and track improvement of current compliance performance to the Medical Priority Dispatch System (MPDS) utilizing Continuous Dispatch Education (CDE) in YAS. To achieve this goal, YAS established which areas of the protocol were lowering the Case Entry compliance, created CDE specific to these trends, and then reassessed compliance. For this study, Case Entry was the focus, as Case Entry protocol compliance was only marginally above the 95% target at 95.75%.
Methods: The Advanced Quality Assurance (AQUA) Agency Performance report was analyzed for both of YAS's Emergency Operation Centers (EOC) and the most common Case Entry deviations across both sites were established. The Quality Audit Team created CDE specific to these areas and over the following months the trends were monitored and additional CDE put in place as necessary.
Results: The study began in November 2012 with initial identification of deviations; deviations initially identified were lack of address verification (seen in 10% of calls), lack of telephone number verification (2% of calls), and freelance questions (4% of calls). CDE of varying types was presented during the year lasting from November 2012 to November 2013, and compliance was measured at regular intervals. The percentage of deviations decreased considerably in April 2013 from the previous month's figures, from 9% to 7% for address verification and from 3% to 2% for telephone verification after the "AMPDS Update Verification Special" was distributed to all EMDs as a mandatory read-and-sign document. Address verification deviations decreased again significantly from 7% to 2% during November, although telephone verification deviations increased marginally from 2% to 3%.
Conclusion: YAS found a direct correlation between CDE and the increase of performance in each of the desired areas. Therefore, structured CDE can clearly improve compliance performance, particularly when it is mandatory for all staff. This was when the largest increase in protocol compliance occurred. Frequent and varied CDE in an area with initially slow improvement continues to have a positive effect on protocol compliance, as highlighted through the improvement in address verification. While the number of freelance questions initially fell, that number continued to fluctuate intermittently over the next few months, peaking at 4%. Feedback regarding freelance questions was addressed through regular audit reports, and compliance in this area had stabilized at 2% but increased again to 4% in November. The percentage of telephone verification deviations has remained steady at an average 2% for the 13 months reviewed. In November 2013, the final month of the study, YAS's Case Entry compliance score was 98.05%.