Two of the most prominent trends in healthcare right now—paradoxically— are diversification and mergers. Many larger healthcare entities are swallowing smaller ones, creating central hubs that offer huge varieties of services and smaller, outlying branded clinics that feed into the hubs. What this means for patient care remains to be seen. What it means for diversification within each organization, though, is already becoming apparent. Larger, merged entities can offer more varied continuums of care, including for example emergency services that lead directly into on-site rehabilitation and affiliated home nursing services.
The same trend is visible in emergency dispatching agencies. In some cities, fire, police, and medical dispatching are merging into single units. In others, emergency services are taking on new roles such as community paramedicine and even community safety education. It’s appropriate, then, that the Annals are moving in the same direction, expanding the types of research and the issues that they address. In the current issue, we see some of this new diversification, both in topic and in approach.
Two papers look at the growing practice of telenursing—specifically, telephone nurse triage housed within the 911 center and connected directly to the emergency response system. The two papers take very different looks at this process. One takes on the economic side of the question, providing promising evidence that placing trained nurses in 911 centers can reduce the overall cost of care for many patients who use the emergency response system as a healthcare entry point for nonemergency conditions. The second reports on the demographics of the system, investigating who uses such a service and how this might affect its management in the future.
Another paper looks at fire service dispatching, a topic that hitherto has seen almost no research at all. Here, the authors report on median call prioritization times (how long it takes to evaluate the caller’s situation and assign a dispatch code, or severity level), providing insight into an issue that is high on every fire service’s list of priorities.
Finally, we are pleased to include here a paper reporting not on the mechanics or cost of dispatching, but on those who do the work, the dispatchers. Although significant work has been done in the areas of stress and trauma in front-line emergency responders, very little has looked at the impact of dispatchers’ work on their quality of life. Here, the authors report on a survey that begins to show us the deep effects emergency calltaking can have on the person taking the call.
The impact of the increasing number of mergers on patients, healthcare workers, and emergency personnel is not yet clear. What is clear, though, is that the more we can offer a smooth continuum of care (for example, by offering nurse triage within the 911 center), and the better we can scientifically examine the nature of dispatch work itself (whether in terms of times or quality of life), the better the service we will be able to offer those who call for our help—including dispatchers themselves.
Isabel Gardett, PhD