Fusion of dispatching centres into one entity: effects on performance

Finnish Office for Health Technology Assessment at the National Institute for Healthand Welfare, Helsinki, FinlandBackground: Dispatching centres were fused into one ofthe 112 entity, which caused concerns regarding whetherthe medical calls could be processed effectively also in thenew centre. We evaluated the effects of the reform on keyperformance criteria in medical calls.Methods: This observational study in the Helsinki Dis-patching Centre consisted of two periods: Period I 2 yearsbefore the reform and Period II 2 years after. The mainoutcome measures were answering and call processingtimes, accuracy of risk assessment and appropriate use ofambulances.Results: In Period I (n5574,276), 92.2% of all incomingphone calls were answered within 10s and in Period II(n5758,022) 82.8% (Po0.0001). Time to dispatch a firstresponding fire unit increased from 98 to 113s (Po0.0001)and an advanced life support unit in category A callsincreased from 73 to 84s (Po0.0001). In Period I 47.7%,34.8% and 17.5% of phone calls were completed ino3, 3–5and 45min and in Period II 29.8%, 36.1% and 34.1%(Po0.0001). The number of three studied non-transporta-tion call types and unnecessary lights-and-siren responsesincreased significantly (Po0.0001 and 0.0001, respec-tively). Neither the accuracy of risk assessment in the threestudied call types nor the rateof telephone-guided cardi-opulmonary resuscitation changed.Conclusions: The reform increased the total number ofambulance dispatches, prolonged answering and call pro-cessing times and had a negative effect on the appropriateuse of ambulances. The accuracy of risk assessment wasnot affected. Evidence-based data should be the basis forthe future as dispatching centre processes are shown to bevulnerable during organisational reforms.