Evaluating the Effect of Proper Use of "Tell Me Exactly What Happened" Case Entry Questions on Chief Complaint Selection and Information Gathering at Emergency Police Dispatch
Steve Zenes, ENP, CMCP, and Nancy Roller
May 08, 2019|Original Research, Poster Abstracts, Research Posters, Research Workshop
The most critical and difficult part of the Emergency Police Dispatcher's (EPD) job may be the gathering of the initial problem description, which uses a scripted Protocol Case Entry Question (CEQ) but also requires interpretation on the part of the EPD. Specifically, at the beginning of the call, the EPD asks the caller the CEQ "Ok, tell me exactly what happened" (TMEWH). Based on the caller's response, the EPD selects a Chief Complaint (CC) Protocol—a specific protocol that provides the prompts to drill down into the caller's situation—the primary reason for calling 911. Selecting the wrong CC can lead to gathering incomplete information (including missing safety information that is valuable for officers), not providing needed instructions, or sending the wrong type of response.
The primary objectives of this study were to: 1. Determine whether asking, TMEWH CEQ provides information that is useful later in the call (in terms of CC selection, KQ answers, and final coding). 2. Identify the effect of asking TMEWH CEQ on total call prioritization time [CPT] (elapsed time from launching the call triaging system [ProQA®] and attaining finagling code).
Materials and Methods:
This was a retrospective study involving review of audio recordings of calls handled on the Police Priority Dispatch System (PPDS®). Calls were collected during normal quality assurance (QA) call review at the participating agencies: Morris County Department of Law and Public Safety, New Jersey, and Williamson County Emergency Communications, Texas. Data included whether the TMEWH CEQ was asked, how many of the KQs were considered obvious, the total number of KQs, whether the correct CC was chosen, and the total CPT.
A total of 425 audio files were reviewed (224 from Morris County, New Jersey and 201 from Williamson County, Texas). Of the total KQs for the CC selected, the median proportion of the number of KQs that were obvious (or should have been obvious) was 33% (IQR: 36%) for all cases.
Asking the TMEWH CEQ did have a statistically significant impact on the appropriateness of the initial CC that was selected (p<0.001). However, asking the TMEWH CEQ did not significantly vary (statistically) by the presence of a spontaneous caller statement (p=0.803). The elapsed time to final coding did not differ significantly by whether the TMEWH CEQ was asked (p=0.582); nor did total elapsed case processing time differ significantly by whether the TMEWH was asked (p=0.447). While the median values of the total number of KQs asked varied (Table 1), no statistically significant relationship was observed (p=0.112). No statistically significant relationship was seen between use of TMEWH CEQ and total number of Obvious (or should have been) KQs (p=0.535).
Compliance to the protocol was particularly high in this convenience sample, resulting in only 5.9% of cases being non-compliant (i.e. not using the TMEWH CEQ). The following trends were seen: · TMEWH was significantly associated with more appropriate initial CC selection. · Use of TMEWH did not have an impact on either total KQs or number of obvious (or should have been) KQs. · Use of the TMEWH CEQ did not have a statistically significant impact on the elapsed time to final dispatch (CPT) or total case time. Future studies may want to focus on more non-compliant calls in order to determine what relationships may be present.
EPDs appear to be effective at identifying when a spontaneous caller statement, provided at the opening of a call, is sufficient to determine the appropriate CC selection. Asking the TMEWH CEQ does not significantly increase call time and provides important information when the caller does not present a sufficient problem description spontaneously. EPDs should err on the side of asking the TMEWH CEQ when unclear whether the spontaneous caller statement is sufficient to enable EPDs to select an appropriately CC.
Daniel Ashwood, PhD; Isabel Gardett, PhD; and Chris Olola, PhD, for their support in study design, data analysis and review.
Steve Zenes: email@example.com Nancy Roller: firstname.lastname@example.org