title: Fusion of dispatching centres into one entity: effects on performance.
abstract: BACKGROUND
  Dispatching centres were fused into one of the 112 entity, which caused concerns regarding whether the medical calls could be processed effectively also in the new centre. We evaluated the effects of the reform on key performance criteria in medical calls.
  
  
  METHODS
  This observational study in the Helsinki Dispatching Centre consisted of two periods: Period I 2 years before the reform and Period II 2 years after. The main outcome measures were answering and call processing times, accuracy of risk assessment and appropriate use of ambulances.
  
  
  RESULTS
  In Period I (n=574,276), 92.2% of all incoming phone calls were answered within 10 s and in Period II (n=758,022) 82.8% (P<0.0001). Time to dispatch a first responding fire unit increased from 98 to 113 s (P<0.0001) and an advanced life support unit in category A calls increased from 73 to 84 s (P<0.0001). In Period I 47.7%, 34.8% and 17.5% of phone calls were completed in <3, 3-5 and >5 min and in Period II 29.8%, 36.1% and 34.1% (P<0.0001). The number of three studied non-transportation call types and unnecessary lights-and-siren responses increased significantly (P<0.0001 and 0.0001, respectively). Neither the accuracy of risk assessment in the three studied call types nor the rate of telephone-guided cardiopulmonary resuscitation changed.
  
  
  CONCLUSIONS
  The reform increased the total number of ambulance dispatches, prolonged answering and call processing times and had a negative effect on the appropriate use of ambulances. The accuracy of risk assessment was not affected. Evidence-based data should be the basis for the future as dispatching centre processes are shown to be vulnerable during organisational reforms.
authors.affiliation: Emergency Medical Service, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Määttä
authors.forename: M
authors.initials: M
authors.lastname: Kuisma
authors.forename: T
authors.initials: T
authors.lastname: Väyrynen
authors.forename: M
authors.initials: M
authors.lastname: Nousila-Wiik
authors.forename: K
authors.initials: K
authors.lastname: Porthan
authors.forename: J
authors.initials: J
authors.lastname: Boyd
authors.forename: J
authors.initials: J
authors.lastname: Kuosmanen
authors.forename: P
authors.initials: P
authors.lastname: Räsänen
mesh_terms: D000552:Ambulances / Q000706:statistics & numerical data; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration* / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005387:Finland; D005392:First Aid; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy; D006785:Hospitals, University; D006801:Humans; D010865:Pilot Projects; D018570:Risk Assessment; D013647:Task Performance and Analysis; D013689:Telephone; D013997:Time Factors; D014218:Triage; D014504:Urban Health