The effects of common emergency call system applications in pre-hospital emergency medical services from a lean management perspective: The case of Ordu province, Turkiye

Abstract

Objective: To evaluate the impact of a centralized Common Emergency Call Center (CECC) system on prehospital emergency medical services (EMS) efficiency through the lens of Lean Management principles.

Methodology: This retrospective, longitudinal study analyzed secondary data from Ordu province, Turkey, comparing a 36-month pre-CECC period (2018-2020) with a 48-month post-CECC period (2021-2024). The dataset comprised 2,346,774 calls and 721,897 cases. Key performance indicators, selected as proxies for lean waste (communication, time, transport), were compared using independent samples t-tests.

Results: Following CECC implementation, significant improvements were observed (p<0.001). The call-per-incident ratio, a proxy for communication waste, decreased by 49.0% (from 4.63 to 2.36). Time-based waste was reduced, with respond time of ambulance teams falling by 36.9% and ambulance mobilization time by 23.7%. Transportation waste, measured by distance per incident, decreased by 15.1%. On-time arrival rates improved significantly in both urban (93.9% to 98.4%) and rural (82.2% to 89.2%) areas. These gains were achieved without a statistically significant increase in the patient load coefficient.

Conclusion: The centralized CECC system, acting as a structural lean intervention, significantly reduced operational waste and improved efficiency in prehospital EMS. This centralized CECC model offers a scalable blueprint for health systems seeking to enhance emergency care delivery.