Table 3 Medical dispatchers’ perception of dispatcher related factors influencing emergency call handling

Using the experience to assess symptoms

[FG1] “If we take someone with chest pain. Many of us have been working in an emergency department for many, many years. Then you have seen all these. Somehow you can imagine a lot of situations, when you have seen so many things”

Registered nurses use their experience from emergency departments to assess symptoms

Experience

Expertise

Using the experience to assess the situation

[FG2] “when you’ve worked in an ambulance for many years, and have seen people’s homes and seen how people live. I create a picture, that’ what I do. The same thing happens in road traffic accidents. Then I work with the information I get and then I can imagine, that’s the way I solve the problem”

Paramedics use their experience from the ambulance to evaluate the situation

Lack of updated knowledge

[FG2] “The Index helps me because I need to assess the symptoms. But sometimes I need to relate to what kind of hospital treatment the patient has had. Then it is difficult to know whether the situation is urgent or not (…) I would like some education in certain areas, right”

Besides Danish Index for Emergency Care, the dispatchers need knowledge about new treatments

Medical knowledge

Follow up on calls

[SI3] “sometimes I get the physician in charge to look up the patient in the record. I would like to have access to that. You use it to see if the ambulance personnel’s assessment of the patient, the measured vital signs, the ECG – if it matches the picture you created in your own head. I learn something from that. It’s continuous learning”

The dispatchers increase competence by following up on their calls

Continuous professional development

Paramedics and nurses as colleagues

[FG2] [Paramedic] “I think we use each other’s knowledge.” [Registered nurse] “yes, I think we use each other’s knowledge and experience in certain areas. And it is important, you have to do it, you have to use your colleagues, when you are uncertain”

Paramedics and nurses use each other’s experience mutually

Internal collaboration

Teamwork

Physician in charge

[SI1] “all of us at the dispatch center need information about whether something is happing (in town). So people know. So people at the emergency hotline know. What is happening when a lot of people start to call. Because they do, if they are worried. Or if they have seen something distant, but something that is part of something large (…) They could just say “this and that are happening right now.” Just so we are warned about people calling about it”

The physician in charge should inform the dispatchers about larger incidents so they are prepared for receiving a lot of calls about it

Collaboration with ambulance personnel

[SI3] “Sometimes we contact the ambulance, if we’ve dispatched an ambulance to something that sounded urgent. And then you can see that the ambulance leaves the scene without the patient. Then okay, why does this not match my perception of the problem? Then we talk about it and I think that the ambulance personnel like it as well, because then we are more like a team, and then we are not just people that forces them to do things”

Dispatchers and ambulance personnel experience the case differently and it is valuable to discuss cases together afterwards

External collaboration

Response time goals

[SI1] “If we can’t live up to the response time goals, and it takes very long time for the ambulance to arrive, then the logistic personnel have to warn us. And then I have to call back to the caller to ask if they are okay or if the situation has worsened”

If the waiting time is long, the dispatchers have the responsibility to reassess the situation by calling back to the caller

Operations management

Organization

Management

[SI2] “the management has to define the standard for what quality the company wants to deliver, and what is meant by good quality. And then it needs to be communicated to the staff, so the staff can get a common understanding of the goal, and somehow try to live up to it.”

The dispatchers need an understanding of the wanted performance level, so they know what to strive for

Supportive decision tool too detailed

[SI3] “it may cause fixation error. And I’ve also talked about it with the ambulance staff. That it is a problem that the information (that is handed over from the dispatch center to the ambulance) is so detailed”

The tool contains too much detail that may increase the risk for fixation error

Supportive decision tool

To take demography into account

[SI4] “If I should adhere to Danish Index for Emergency care accurately, then there is no difference between being 21 or 55 and having chest pain. (…) I can ask the guy at 21 about what he has been doing. And his answer could be that he has been doing workout – then it’s probably muscle soreness, but I have to send an ambulance according to Danish Index”

The tool does not take into account that the age of the patient influence disease occurrence

Gathering the team

[FG1] “it is the management’s responsibility to gather the team. With staff meetings and course days where they teach specific themes. And make sure that people are updated. And that the wanted competence exists. Say “this is what we want, and we will make sure that you have the competences.” Then you will do it”

The management are responsible for gathering the team

Culture in organization

Common understanding

[SI4] “we need a common understanding, a common goal, a common work process. It doesn’t have to be that formal. I sometimes joke with “I think I am doing good, I’ve been here for a long time and I haven’t been fired yet. (…). I assume that my level is good, because I haven’t heard the opposite””

The dispatchers need to know the defined performance level to improve their competence

Culture at dispatch center

[SI4] “we, at the dispatch center, have to have the same approach. That when people call, then it’s because they need help (…). We are at the same team and we have different responsibilities and we have to make things work out, because then we end up with a very good product”

Employees at the dispatch center need an understanding the common goal of helping the patients