Reducing Medical Errors in Emergency Medicine: Implementation of a Real-Time Audit System

Abstract

The goal of this study was to assess the utility of a real-time adherence scoring system for a medical emergency team (MET) in assessing the performance of a pictorial emergency protocol for out-of-hospital cardiac arrest scenarios. The major aims were to evaluate the MET's adherence to the protocol, measure compliance before and after an educational intervention, and evaluate the practicality and feasibility of the system. The MET's adherence to a pictorial protocol for out-of-hospital cardiac arrest scenarios was assessed using a novel real-time video scoring system with multiple raters. The system was easy to use and enabled the raters to view videos remotely and return adherence scores quickly. Pre-intervention, the MET's adherence to the protocol was 42.8% (27/63). Educational sessions and a follow-up video scoring evaluation were provided to the MET at the hospital with the lowest adherence. Following the intervention, the MET's adherence to the pictorial protocol at this hospital improved to 76.3% (30/39), indicating that the educational intervention was successful in improving performance and adherence (L. Gurley et al., 2016); (Scharein & Trendelenburg, 2013). Adherence to protocols is an important quality indicator for METs that can affect patient outcomes. However, scoring these protocols is challenging, as previous scoring systems required complex coding and were not evaluated or reported in detail. In addition, most current scoring assessments focus on checklists or have limited performance measurement capabilities. To address these challenges, an easy-to-use video adherence scoring design with manual and automated scoring options was created. The scoring design was tested with a medical emergency team at a major metropolitan teaching hospital. This system was deemed user-friendly and useful by prospective raters both on-site and off-site, with a mean adherence scoring turnaround time of 1.36 days.