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Decrease in medical command errors with use of a "standing orders" protocol system

C J Holliman1, R C Wuerz, S A Meador

  • 1Emergency Medicine Division, University Hospital, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033.

The American Journal of Emergency Medicine
|May 1, 1994
PubMed
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The new standing orders protocol significantly reduced physician medical command errors by 53% compared to the previous required call-in system. Paramedic error rates remained low, and on-scene times did not increase.

Area of Science:

  • Emergency Medicine
  • Healthcare Quality Improvement

Background:

  • Medical command systems in emergency medical services (EMS) are crucial for patient care.
  • Previous studies indicated higher physician error rates with a "required call-in" system.

Purpose of the Study:

  • To evaluate physician and paramedic error rates under a new "standing orders" protocol.
  • To compare these rates with a prior "required call-in" system.
  • To assess the impact on on-scene time.

Main Methods:

  • Prospective audit of 2,101 prehospital Advanced Life Support (ALS) trip sheets.
  • Physician reviewers identified deviations from regional EMS protocols.
  • Error rates were compared to historical data.

Main Results:

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  • Physician error rate decreased from 2.6% to 1.2% (P < .0001).
  • Paramedic error rate was 0.4%.
  • On-scene time interval did not increase with the standing orders system.

Conclusions:

  • The "standing orders" protocol effectively reduced physician medical command errors.
  • This system maintains low paramedic error rates and does not prolong on-scene times.
  • Standing orders represent a quality improvement for medical command in EMS.