Duration of the phone call in wrong connection to 194 operator

Uvod. Vreme je suštinski važna kategorija u radu službe hitne medicinske pomoći. Dužina razgovora sa pozivaocem bi trebalo da bude optimalna da bi se donele odgovarajuće odluke. Ako je ostvarena telefonska veza usled pogrešnog telefonskog broja, takav razgovor treba da bude što kraći. Cilj rada je bio da se pokaže koliko traju razgovori sa pozivaocem za pozive koji su klasifikovani kao pogrešna veza. Metod. Korišćena je elektronska baza podataka rada na telefonskoj centrali 194/94 iz 2009. godine. Podaci su izvezeni u excel tabelu gde su sortirani i gde je vršeno pretraživanje. Od ukupno 739 742 razgovora, izdvojeno je 93 393 ili 12,62% razgovora koji su klasifikovani kao pogrešno ostvarena veza. Zbog velike varijabilnosti na gornjoj skali vrednosti, izvršeno je skraćivanje baze za 5% najkraćih i najdužih vrednosti. Za obradu, posle skraćenja baze, je ostalo 84 053 poziva. Vreme razgovora je od trenutka kada operater podigne telefonsku slušalicu do trenutka kada se veza sa pozivaocem prekine. Rezultati. Analizom 84 053 ostvarene pogrešne veze, trajanje razgovora je minimalno šest sekundi, maksimalno 194 sekunde, srednja vrednost 30,28 sekundi. Diskusija. Broj pogrešnih veza je veliki u službama u svetu koje se bave hitnom pomoći kao što su vatrogasci, policija i hitna medicinska pomoć iako nema podataka o utrošku vremena na ovakve pozive. Zaključak. Razgovori sa pogrešno ostvarenom vezom predugo traju. U tom smislu, trebalo bi obučavati i operatere i građanstvo. Ključne reči: hitna medicinska pomoć, Beograd, pozivni centar, upravljanje vremenom Abstract


Introduction
Management of time, as a resource, is of essential importance for the City Department of Emergency Medicine (CDEM).It may be split into: the patient`s waiting time before the operator picks up the phone, phone call duration with the operator, time needed for the dispatcher to assign the team, the time needed for the team to reach the location of the emergency, etc. CDEM Belgrade has got a limited capacity, as well as the limited number of phone lines, and the limited number of operators who work there (the phone number used to be 94 and now is 194).The duration of the phone call with the caller dialing 94/194 should be optimal for the dispatcher to decide on accepting or refusing the help, while classifying the calls according to their priority -first or second emergency level.Doctors and nurses working on these phone lines (operators) enter the data into the computer program.The data contain all the necessary information about the patient, the reason for calling, the classification of the emergency, whether it`s the wrong connection or harassment of the Emergency Department (ED), and also other necessary data of value for the ED.While the caller waits to be connected, the machine keeps repeating: "You have reached Emergency Department, please hold''.If the operator picks up right away he usually says: "You have reached Emergency Department.How can I help you?''or ''Emergency Department.What`s your emergency?''.If the caller answers: ''Sorry, wrong number.''or disconnects, the operator will enter the data about the wrong connection.If the caller wants information or advice which doesn`t concern his current health emergency, the operator may give advice, which would be considered a waste of time in favor of those in the real emergency, because there is a separate number for giving medical advice.These calls could be marked as the wrong connection.
A recurrent occurrence is that the same person calls 94/194 from the same number several times and hangs up before finally speaking with the operator.Making the phone call with inappropriate content may be a sign of intentional harassment, winding ED personnel.Nonetheless, these sorts of calls could be placed to different operators, and it`ş difficult for a single operator to discern whether the call was due to the wrong number or intentional harassment of the ED 1 , although the operator has the option to access previous calls of the same caller.In Holand, there is a legislature that defines harassment calls to ED a criminal act and the caller may be sanctioned 2 .There are also explanations of what to do if you accidently call ED 3. So, there is a difference between a wrong connection and accidentally calling ED!An example of accidental calling is if the phone button was accidentally pushed while the phone was in the bag.
cies).One of the challenges the Safety Agency encountered, when people used the number, was the "blank" calls.The Police Department of Delhi had to stop trial research in 2016 and start anew after six month period in 2017.Smartphones have the implemented option of connecting to 112 if the button is tapped three times.But the option to press 8 before connecting with the operator proved to be an efficient solution 4 .
In an article in Spectrum News 1 Austin, published July 7th, 2021, named "Look after your gadgets: Accidental 911 calls are on the rise'' was written: ''Communication center for emergencies in North Texas, Carlton receives more emergency calls which eventually disconnect" 5 .Time spent on these calls isn`t mentioned.
Patricia Scofield and al, while researching the psychological health of the operators in ED dispatch centers, found that the personnel was at a higher risk of burnout due to the lack of control over the work overload, inappropriate training, and lack of management support 6 .Only the first group of operators in CDEM Belgrade attended the training for working as an ED operator and at the initiation of the Index into work.The duration of the call between the caller-operator should be established."The comparing value should be defined to be able to compare results with, or rather the value that will be the benchmark for work quality.This particular value doesn't always need to be reached but it should be something to aspire to" 7 .The longer the call duration, the later the emergency team will reach the destination.The phone call duration is not determined in any of the legal documents of the CDEM, not even in the case of a wrong connection but it`s obvious it should be as short as possible.If the caller`s waiting time to make the connection with the operator is long, ED team will be held back to reach the patient with an emergency.The more wrong connections, which overburden the operator, the longer the waiting time for the patient who wants to reach ED.
Each operator has his own password when logging into the system, so it`s possible to track the number of harassments and wrong connections, as well as the call duration for each operator.
As an instruction for working at the phone dispatch 94/194, we use the Index, which is also used in the Norway ED, "The Norway Index of urgent care''.It was translated into Serbian and used since 2006.Only the first group of operators was trained, while later those who came in their place didn`t go through training 9 .There is no research on time slots with wrong connections.
Our aim was to show how long the phone calls last with the caller who made the wrong connection, as we classified it.

Method
We used the electronic phone call database (194/94) for 2009.Out of the total of 739.742 calls we singled out 93.393, which makes 12.62%, and they were classified by the operator as the wrong connection.The data were put in a spreadsheet (Excel table) where they were sorted and researched.We singled out only those marked as the wrong connection, emergency level 3 because there were those qualified as harassment but marked as emergency level 1 or 2, which is an unintentional mistake.Due to the great variability in the upper scale of the values we cut the base for 5% of the shortest and longest calls measured in seconds.There were 84.053 calls left to process.The phone call duration was measured from the moment the operator picked up the phone to the moment the line was disconnected.

Discussion
The minimal call duration was 6 seconds and the maximal 196 seconds, with an average value of 30.28 seconds.49.48% of our wrong connections lasted longer than 15 seconds, and 4.67% lasted longer than 120 seconds.
In the research of Ellensen EN, Hunskaar S, Wisborg T, and Zakariassen E, out of the total of 3.294 calls, there were 237 wrong connections, which make 7,19%, and it is less than in our research 10 .
In the research of Zivanović M, the mean value of the duration of accepted phone calls, classified as the first level of emergency, was 1 minute 58 seconds.The mean value for the duration of the calls for the emergency 2 level was 2 minutes 27 seconds 7 .In our research, the mean value was 30.28 seconds and it was shorter than the mean value of the call duration of level 2 emergency calls.Although, from personal experience, in the majority of cases, 15 seconds is more than enough to establish whether it`s the wrong connection.
One part of the conversation lasts too long, possibly due to an operator giving some medical information to a caller, which he shouldn`t be doing because that way he prolongs the waiting time for the severely ill patients who are trying to reach ED 8 .There is a separate phone number for those who seek medical advice and the waiting time to reach the operator on this number is not short and it may be up to 4 minutes 22 seconds 8 .
In India, out of 15.672 accepted calls at an emergency number, in one day, 10.288 were ''blank'' 4 .Not even here, the call duration and personnel load were mentioned.The waste of time was probably long.
In the Israeli National Center for Emergency Medicine, during 2012-2016, after special surveillance technology was implemented, the incidence of harassment calls dropped significantly from 10.9% to 2.9%, and in the region of Jerusalem from 26.5% to 2.0% 11 .The problem must be solved with better training of the personnel working on the phone lines, setting standards for time duration slots for the calls between caller and operator, with the help of the Ministry of health and phone call providers, who could provide technical support to disable these calls, as was the case in Israel.

Conclusion
The phone calls, in the case of a wrong connection, last too long.Time management should be much better.The operators need to be trained as well as the citizens on the importance of this resource.