Effect of a Comprehensive Quality Management Process on Compliance With Protocol in an Emergency Medical Dispatch Center,☆☆,

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Abstract

Study objective: Modern emergency medical dispatch provides appropriate resource responses with the use of an emergency medical dispatch priority reference system (EMDPRS). The EMDPRS is a systematic protocol for all aspects of the dispatch process, including interrogating the caller, matching responses with severity, and providing pre-arrival care. We tested the hypothesis that appropriate performance feedback would increase dispatcher compliance with the protocol. Methods: We examined how emergency medical dispatchers complied with the protocols contained in the Advanced Medical Priority Dispatch System, a commercially available EMDPRS. Six key areas and overall compliance were studied. Dispatchers performed for 2 months without feedback and for a further 2 months with performance feedback. We used statistical methods to compare the dispatchers’ compliance with the protocols each month. Results: The mean overall compliance score improved from 76.4%±10.2% (mean±SD) in the absence of performance feedback to 96.2%±4.0% (n=217; P <.001) when performance feedback was provided. Five of 6 key areas showed similar improvements. Conclusion: Providing emergency medical dispatchers with regular and objective feedback regarding their performance dramatically improves how rigorously they follow a systematized dispatch protocol.[Clawson JJ, Cady GA, Martin RL, Sinclair R: Effect of a comprehensive quality management process on compliance with protocol in an emergency medical dispatch center. Ann Emerg Med November 1998;32:578-584.]

Section snippets

INTRODUCTION

The American Society for Testing and Materials (ASTM) issued guidelines for emergency medical dispatch (EMD), EMD training and certification, and EMD management in designations F1258-95, F1552-94, and F1560-94.1, 2, 3 In these, the ASTM recommended not only that all emergency medical dispatchers use a medically approved emergency medical dispatch priority reference system (EMDPRS) but also that ongoing quality assurance activities include extensive case review and regular feedback to the

MATERIALS AND METHODS

Training on the use of the AMPDS was completed by the test center in July 1993. After a 1-month gap to allow the dispatchers to adjust completely to the new system, we began formal monitoring of their compliance with the protocol. During September and October 1993, we evaluated dispatchers’ performance in the absence of any feedback. At the end of October, a performance-feedback and CDE program was started; monitoring continued until the end of December to evaluate its effects.

The AMPDS uses

RESULTS

All 32 communications center dispatchers successfully completed the EMD course and received NAEMD certification on the use of the AMPDS. Approximately 100 cases were reviewed each month, including 25 to 29 dispatchers with an average of approximately 4 cases per dispatcher. The additional (NAEMD) reviewer did not identify any discrepancies between the in-house reviewer’s interpretation of the re-reviewed cases and the grading standard. The scores for those dispatchers who received multiple

DISCUSSION

This study evaluated how rigorously a group of 32 emergency medical dispatchers complied with an EMD protocol. During the first 2 months of the study, the dispatchers did not receive CDE or feedback on their levels of performance; during the last 3 months, they were given feedback concerning their previous performance and were provided with CDE.

The study examined overall compliance with the protocol and compliance in 6 key areas (which together covered all aspects of the dispatch process).

Acknowledgements

We acknowledge the invaluable assistance of Doug Smith-Lee, Emergency Medical Services Manager, and Thera Bradshaw, Director, Clark Regional Communications Agency, and of Lynn Wittwer, MD, Director, and Marc Muhr, Assistant Director, Clark County Medical Program, Vancouver, Washington, for sharing with us the details of the quality improvement program and the compliance-with-protocol performances of the Clark County dispatchers.

References (19)

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From Medical Priority Consultants, Inc,* and National Academy of Emergency Medical Dispatch, Salt Lake City, UT.

☆☆

Address for reprints: Jeff J Clawson, MD, Medical Priority Consultants, Inc, 139 East South Temple, Suite 500, Salt Lake City, UT 84111.

0196-0644/98/$5.00 + 0 47/1/93445

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