Salerno S M, Wrenn K D, Slovis C M
Department of Emergency Medicine, Strong Memorial Hospital, Rochester, New York.
Ann Emerg Med. 1991 Dec;20(12):1319-24. doi: 10.1016/s0196-0644(05)81074-1.
To determine the incidence, type, and outcome of protocol deviations in an emergency medical services (EMS) system.
Retrospective consecutive case series.
Seven advanced life support ambulance services servicing five area hospital emergency departments.
1,246 patients requiring advanced life support care.
None.
Advanced life support ambulance runs during a two-month period were examined for protocol deviations. Of 1,246 runs examined, 16% had deviations. Approximately 55% of these deviations were minor, 38% were serious, and 7% were very serious in nature. The effects of the errors were evaluated using hospital records. Results showed that 89.5% of patients were unaffected, 5.0% improved, and 5.5% suffered complications from deviations. Emergency medical technicians committed 69% of the deviations without the consent of medical control, medical control committed an additional 18%, and both were responsible in 13% of cases. Incomplete histories were found in 8% of cases.
Protocol deviations committed in prehospital care do not usually cause direct harm to patients. On review of these deviations, however, several disturbing trends were uncovered, including misconceptions in the use of IV therapy, a number of serious deviations in advanced cardiac life support protocols, and lack of communication with medical control. This type of quality assurance study has the ability to identify areas of strength and weakness in an EMS system, allowing planning of ongoing educational efforts in the system.
确定紧急医疗服务（EMS）系统中方案偏离的发生率、类型及结果。
回顾性连续病例系列研究。
为五家地区医院急诊科提供服务的七家高级生命支持救护车服务机构。
1246例需要高级生命支持护理的患者。
无。
对为期两个月的高级生命支持救护车出诊情况进行检查，以查找方案偏离情况。在检查的1246次出诊中，16%存在偏离。其中约55%的偏离为轻微偏离，38%为严重偏离，7%为非常严重的偏离。利用医院记录评估这些差错的影响。结果显示，89.5%的患者未受影响，5.0%的患者病情改善，5.5%的患者因偏离出现并发症。紧急医疗技术人员在未经医疗控制人员同意的情况下造成了69%的偏离，医疗控制人员造成了另外18%的偏离，在13%的病例中两者均有责任。8%的病例存在病史记录不完整的情况。
院前护理中出现的方案偏离通常不会对患者造成直接伤害。然而，在对这些偏离进行审查时，发现了一些令人不安的趋势，包括静脉治疗使用方面的误解、高级心脏生命支持方案中的一些严重偏离以及与医疗控制人员缺乏沟通。这种质量保证研究能够识别EMS系统中的优势和薄弱环节，有助于规划该系统中持续的教育工作。
