Recommendations for further research

The study has revealed a number of issues requiring further investigation and research. These are:

• Further development of EMD systems to improve their ability to identify calls suitable for telephone assessment and advice

• Development of a system for gathering cumulative evidence about the pass back rates of individual EMD codes transferred for further advice and

assessment so that services can make a more informed choice about which codes to use for referral. This could be a collaborative study with all services using telephone advice as an alternative response for low priority 999 calls contributing routine data on call outcome.

• More detailed investigation of the factors that influence the nurse (or other assessors) decision about whether or not to return a call to the ambulance service so that pass back rates can be minimised.

• Evaluation of integrated systems as they develop and further investigation of who should provide telephone advice and where.

• Development of a system for measuring and monitoring adverse events that may result from alternative management of category C ambulance calls. This includes all alternatives, for example delayed response, and not just

Acknowledgments

This study was commissioned by the NHS Executive Service Delivery and Organisation R&D programme.

The authors would like to thank the study ambulance and NHS Direct Services for their invaluable contribution and in particular to the Emergency Medical Dispatchers and Nurse advisers without whose cooperation the study could not have been

completed. We also thank the related NHS trust boards for their support of the study. The implementation of the new service resulted from the enthusiasm and

commitment of service managers. For ambulance services these were Tracy Mellor (GMAS), Huw Davies and Roz Paskin (Wales) and Chris Gaskill and Paul Jardine (Two Shires). For NHS Direct these were Kathy Agrebi and Lynne Parkes (Greater Manchester, Cheshire & Wirrall NHS Direct), Chris Powell and Julia Pridmore (NHS Direct Wales) and Amanda Curtis (TVN NHS Direct).

We would also like to thank Dr JJ DeGorter for medical advice and his contribution to the study design and implementation, Brendan Doyle (GMAS), Paul Jardine (TSAS) and Beryl Hill (TVN NHS Direct) for data retrieval and our colleague Joanne Casson for clerical and administrative support.

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