Introduction: The yellow code represents a situation of moderate urgency, in which the patient is in potential life-threatening danger. As one of the most frequently used codes in the Operations Center, it is essential to evaluate the appropriateness of its assignment. It is equally important to investigate possible correlations with specific pathologies, locations, times, and differences with other Operations Centers, as well as to analyze the phenomena of under and over triage. Objectives: The research aims to identify the main variables that influence the assignment of color codes, with particular attention to the yellow code, and to analyze the decision-making process of operators in assigning this code. Materials and Methods: The study is quantitative, observational, and descriptive in nature and was conducted at the 118 Operations Center of AST in Ancona, located within the "Ospedale Regionale di Torrette." For the first sample, data was collected using data analysis software such as Excel and Power BI, including missions from the year 2023. For the second sample, composed of the Operations Center staff, data was collected through a paper-based questionnaire. Results: Starting from the analysis of the total codes (=55,069) recorded in one year, the yellow dispatch codes amount to 32,067. Considering various variables, it emerges that the most frequently associated pathology with the yellow code is trauma (C01), accounting for 23.67% of cases, followed by cardiovascular conditions (C02) at 15.16%, and respiratory conditions (C03) at 11.08%. Through comparison with other Operations Centers, the one with the highest rate of yellow codes was identified as the Macerata Operations Center (60.20%), compared to Ancona (57.67%), Ascoli Piceno (49.38%), and Pesaro (40.02%). Regarding the locations of code assignment, most yellow codes were assigned in domestic settings (69.52%), followed by roads (12.61%) and other locations (11.69%). In terms of timing, most yellow codes were registered in the morning hours (42.90%), followed by the afternoon (25%) and evening (20.30%). The analysis showed that in 57.45% of cases, the yellow dispatch code remained unchanged upon return. Additionally, 81.88% of patients with a yellow code were transported to the hospital. Regarding the phenomenon of over-triage, out of 32,067 yellow codes, 10,147 fall into this category, with a higher incidence in ENT conditions (C12) at 43.45%, “other pathology” (C19) at 40.50%, and poisonings (C07) at 38.24%. Conversely, 554 cases correspond to under-triage, with this phenomenon being more frequent in oncological conditions (C06) at 3.59%, respiratory conditions (C03) at 3.09%, and neurological conditions (C04) at 2.94%. Considering the mode of transport, it emerged that in 63.52% of cases, a basic rescue vehicle was used to respond to a medium-severity emergency. Finally, analyzing the feedback from Operations Center staff, it was found that in 28.30% of cases, the yellow code is assigned in situations of uncertainty. Discussion and Conclusion: The yellow code encompasses a wide variety of cases; there may be a tendency to resort to this code when uncertainty prevails during telephone assessment for various reasons. This uncertainty is more common in certain conditions (respiratory, neurological, oncological), but conducting a thorough telephone interview can reduce this "gray area" and increase the appropriateness of the Operations Center triage. It is, however, evident and necessary to minimize the variability in evaluation among different operators.
Introduzione: Il codice giallo rappresenta una situazione di urgenza moderata, in cui il paziente è in potenziale pericolo di vita. Essendo uno dei codici più frequentemente utilizzati in Centrale Operativa è fondamentale andarne a valutare l’adeguatezza dell’assegnazione. È altrettanto importante indagare su eventuali correlazioni con specifiche patologie, luoghi, orari e differenze con altre Centrali Operative, oltre ad analizzare i fenomeni di under e over triage. Obiettivi: La ricerca mira ad individuare le variabili principali che influenzano l’assegnazione dei codici-colore, con particolare attenzione al codice giallo e analizzare la scelta di attribuire questo codice da parte degli operatori. Materiale e metodi: Lo studio è di tipo quantitativo – osservazionale - descrittivo ed è stato condotto presso la Centrale Operativa 118 della AST di Ancona, ubicata all’interno della struttura “Ospedale Regionale di Torrette”. Per il primo campione i dati sono stati raccolti mediante software di analisi dati, come Excel e Power BI ed includono le missioni relative all’anno 2023. Nel caso del secondo campione, composto dagli operatori della Centrale Operativa, è stata effettuata la raccolta mediante un questionario cartaceo. Risultati: Partendo dall’analisi dei codici totali (=55.069) registrati in un anno, sono stati esaminati i codici gialli di invio che ammontano a 32.067. Considerando diverse variabili, emerge che la patologia più spesso associata al codice giallo è quella traumatica (C01), che rappresenta il 23,67% dei casi, seguita da quella cardiocircolatoria (C02) con il 15,16% . Attraverso il confronto con altre Centrali Operative è stato possibile rilevare quella con un tasso più elevato di codici gialli, che risulta essere la Centrale Operativa di Macerata (60,20%), rispetto ad Ancona (57,67%), Ascoli Piceno (49,38%) e Pesaro (40,02%). Per quanto riguarda i luoghi di attribuzione, la maggior parte dei codici gialli è stata assegnata in ambiente domestico (69,52%), seguita dalle strade (12,61%). Considerando l’orario, la maggior parte dei codici gialli è stata registrata nella fascia oraria mattutina (42,90%), seguita dal pomeriggio (25%) e dalla sera (20,30%). Dall’analisi è emerso che nel 57,45% il codice giallo di invio rimane invariato al rientro. Inoltre, l’81,88% di pazienti con codice giallo sono stati trasportati in ospedale. Riguardo al fenomeno dell’over triage, su 32.067 codici gialli, 10.147 rientrano in questa categoria, con un’incidenza maggiore nelle patologie otorinolaringoiatriche (C12), con una percentuale del 43,45%. Al contrario, 554 casi corrispondono all’under Triage, questo fenomeno è più frequente nelle patologie neoplastiche (C06) con il 3,59%, le patologie respiratorie (C03) con il 3,09% ed infine le neurologiche (C04) con il 2,94%. Considerando il mezzo di trasporto è emerso che nel 63,52% dei casi viene utilizzato il mezzo di soccorso di base per rispondere ad un’emergenza di media gravità. Infine, analizzando il feedback degli operatori della Centrale Operativa è emerso che nel 28,30% gli operatori assegnano il codice giallo in situazioni di incertezza. Discussione e conclusione: Il codice giallo raccoglie al suo interno un insieme di casi molto variegati; la tentazione può essere quella di ricorrere a questo codice - colore quando prevale l’indeterminatezza della valutazione telefonica, per una serie di ragioni. Tale indeterminatezza è più frequente in alcune patologie (respiratoria, neurologica, neoplastica), ma l’attenta effettuazione dell’intervista telefonica può ridurre tale quota di “grigio” ed aumentare l’appropriatezza del triage di Centrale. Risulta comunque evidente e necessario ridurre al minimo la variabilità di valutazione tra i diversi operatori.
Il codice giallo nel Triage telefonico del 118: valutazione dell’appropriatezza ed analisi delle variabili
GASPARRONI, AURORA
2023/2024
Abstract
Introduction: The yellow code represents a situation of moderate urgency, in which the patient is in potential life-threatening danger. As one of the most frequently used codes in the Operations Center, it is essential to evaluate the appropriateness of its assignment. It is equally important to investigate possible correlations with specific pathologies, locations, times, and differences with other Operations Centers, as well as to analyze the phenomena of under and over triage. Objectives: The research aims to identify the main variables that influence the assignment of color codes, with particular attention to the yellow code, and to analyze the decision-making process of operators in assigning this code. Materials and Methods: The study is quantitative, observational, and descriptive in nature and was conducted at the 118 Operations Center of AST in Ancona, located within the "Ospedale Regionale di Torrette." For the first sample, data was collected using data analysis software such as Excel and Power BI, including missions from the year 2023. For the second sample, composed of the Operations Center staff, data was collected through a paper-based questionnaire. Results: Starting from the analysis of the total codes (=55,069) recorded in one year, the yellow dispatch codes amount to 32,067. Considering various variables, it emerges that the most frequently associated pathology with the yellow code is trauma (C01), accounting for 23.67% of cases, followed by cardiovascular conditions (C02) at 15.16%, and respiratory conditions (C03) at 11.08%. Through comparison with other Operations Centers, the one with the highest rate of yellow codes was identified as the Macerata Operations Center (60.20%), compared to Ancona (57.67%), Ascoli Piceno (49.38%), and Pesaro (40.02%). Regarding the locations of code assignment, most yellow codes were assigned in domestic settings (69.52%), followed by roads (12.61%) and other locations (11.69%). In terms of timing, most yellow codes were registered in the morning hours (42.90%), followed by the afternoon (25%) and evening (20.30%). The analysis showed that in 57.45% of cases, the yellow dispatch code remained unchanged upon return. Additionally, 81.88% of patients with a yellow code were transported to the hospital. Regarding the phenomenon of over-triage, out of 32,067 yellow codes, 10,147 fall into this category, with a higher incidence in ENT conditions (C12) at 43.45%, “other pathology” (C19) at 40.50%, and poisonings (C07) at 38.24%. Conversely, 554 cases correspond to under-triage, with this phenomenon being more frequent in oncological conditions (C06) at 3.59%, respiratory conditions (C03) at 3.09%, and neurological conditions (C04) at 2.94%. Considering the mode of transport, it emerged that in 63.52% of cases, a basic rescue vehicle was used to respond to a medium-severity emergency. Finally, analyzing the feedback from Operations Center staff, it was found that in 28.30% of cases, the yellow code is assigned in situations of uncertainty. Discussion and Conclusion: The yellow code encompasses a wide variety of cases; there may be a tendency to resort to this code when uncertainty prevails during telephone assessment for various reasons. This uncertainty is more common in certain conditions (respiratory, neurological, oncological), but conducting a thorough telephone interview can reduce this "gray area" and increase the appropriateness of the Operations Center triage. It is, however, evident and necessary to minimize the variability in evaluation among different operators.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/19797