Medical command errors in an urban advanced life support system

Abstract

Study objective: The aim of this study was to assist in focusing educational efforts for command physicians by identifying the most common types of errors made by on-line medical command. Design: Retrospective survey of prehospital advanced life support (ALS) trip sheets. Setting: An urban ALS paramedic service with on-line physician medical command rotating on a monthly basis among three hospitals. Participants: From September 1988 through December 1990, all ALS run sheets were reviewed as part of an ongoing quality assurance program. Cases were identified as deviating from regional emergency medical services protocols as judged by agreement of three physician reviewers. Cases were excluded if all three reviewers did not agree that the command rendered was inappropriate. Interventions: Command errors were identified from the prehospital ALS run sheets and categorized. Results: One hundred ninety-four command errors in 167 cases were identified from 3,839 runs (4.4% of all runs). Six types of errors accounted for 80% of the total errors, with the most common error (34%) being failure to address the possibility of hypoglycemia with altered level of consciousness. Error rate decreased from 7.9% to 2.6% of total runs during the study period. Conclusion: To reduce the medical command error rate, physician education should be directed at the six problem areas identified. Ongoing quality assurance review of medical command may result in a decrease of the command error rate.