Blue calls - time for a change?

Prior alert via a landline telephone ("blue call") is commonly used to warn accident and emergency (A&E) departments of the impending arrival of a seriously ill or injured patient. There are no published indications for making such calls or validated protocols on message content. Submitted telephone information has the potential for distortion as it is passed through the control centre resulting in inappropriate resource allocation. This study focuses on the quality and content of the message in the context of the available patient details as well as reviewing the clinical indications for the call. Data were collected on patients for whom "blue calls" were made to an A&E department over three months of 1998. Patients with life threatening conditions who were brought by non-blue light ambulance were identified during the same period. Similar details were collected on these critical patients. Of the 189 "blue calls" with complete details, 73% were admitted, (12% to ITU) and 18% died. Sixty nine per cent of cases were medical, 26% trauma and 5% obstetric. Pre-hospital observations were missing for 25% of patients (excluding patients in cardiac arrest), suggesting that the decisions to make a pre-alert call may have been based on subjective criteria in a significant minority. Information given over the telephone invariably included age, sex and presenting complaint but details of the current condition of the patient were included in only 11%. On reviewing pre-hospital information, a consultant in A&E and an ambulance paramedic judged that a prior alert was justified in 93% but additional information would be helpful in 52% of cases to correctly mobilise resources. Seventy five "clinically critical" patients were found in the three months of the study. Clinically critical patients were patients who had no prior alert, transported by ambulance, who were subsequently admitted to intensive care, theatre, or other high dependency areas. They included 27 patients with symptoms of a myocardial infarction. These patients may have benefited from prior alert. A protocol is suggested to provide criteria for making a prior alert to the A&E department via a landline connection. A standardised message structure would be used using vital signs and mechanism of injury or type of illness to assist in hospital preparation.