Ornato J P, Doctor M L, Harbour L F, Peberdy M A, Overton J, Racht E M, Zauhar W G, Smith A P, Ryan K A
Department of Emergency Medicine, Virginia Commonwealth University/Medical College of Virginia, Richmond, USA.
Ann Emerg Med. 1998 Apr;31(4):483-7. doi: 10.1016/s0196-0644(98)70258-6.
Erroneous time documentation of emergency treatment caused by the variation in the accuracy of timepieces has profound medical, medicolegal, and research consequences. The purpose of this study was to confirm the variation of critical timepiece settings in an urban emergency care system noted in previous studies and to implement and monitor the results of a prospective program to improve time synchronization.
Timepieces (n = 393) used by firefighters, paramedics, and emergency physicians and nurses were randomly sampled immediately before and at two time intervals (1 and 4 months) after attempted synchronization to the US atomic clock standard. The setting on each timepiece was compared with the atomic clock. From the data, a mathematical simulation estimated the number of time-related documentation errors that would occur in 2,500 simulated cardiac arrest cases using timepieces with accuracy similar to those found in the EMS system before and after attempted synchronization.
Before attempted synchronization, the timepieces had a mean error of 2.0 (95% confidence interval 1.8 to 2.3) minutes. One month after attempted synchronization, the mean error decreased significantly to .9(.8 to 1.1) minute. However, it increased to 1.7 (1.5 to 1.9) minutes within 4 months. Mathematical simulation before attempted synchronization predicted that 93% of cardiac arrest cases would contain a documentation error of 2 minutes or more and that 41% of cases would contain a documentation error of 5 minutes or more. Attempted synchronization cut the 2-minute documentation error rate in half and reduced the 5-minute documentation error rate by three fourths. However, the error rates were predicted to return to baseline 4 months after attempted synchronization.
Emergency medical timepieces are often inaccurate, making it difficult to reconstruct events for medical, medicolegal, or research purposes. Community synchronization of timepieces to the atomic clock can reduce the problem significantly, but the effects of a one-time attempted synchronization event are short-lived.
由于时钟准确性的差异导致急诊治疗时间记录错误，这会产生严重的医学、法医学和研究后果。本研究的目的是确认先前研究中提到的城市急诊护理系统中关键时钟设置的差异，并实施和监测一项旨在改善时间同步的前瞻性计划的结果。
在试图与美国原子钟标准同步之前以及同步后的两个时间间隔（1个月和4个月），对消防员、护理人员以及急诊医生和护士使用的时钟（n = 393）进行随机抽样。将每个时钟的设置与原子钟进行比较。根据数据，通过数学模拟估算了在2500例模拟心脏骤停病例中，使用与急诊医疗服务（EMS）系统在试图同步之前和之后所发现的准确性相似的时钟时，可能出现的与时间相关的记录错误数量。
在试图同步之前，时钟的平均误差为2.0分钟（95%置信区间为1.8至2.3分钟）。在试图同步后的1个月，平均误差显著降至0.9分钟（0.8至1.1分钟）。然而，在4个月内又增加到了1.7分钟（1.5至1.9分钟）。在试图同步之前的数学模拟预测，93%的心脏骤停病例会有2分钟或更长时间的记录错误，41%的病例会有5分钟或更长时间的记录错误。试图同步将2分钟记录错误率降低了一半，将5分钟记录错误率降低了四分之三。然而，预计在试图同步后的4个月，错误率会恢复到基线水平。
急诊医疗时钟常常不准确，这使得难以出于医学、法医学或研究目的重建事件。将时钟与原子钟进行社区同步可以显著减少该问题，但一次性试图同步事件的效果是短暂的。
