Effect of a comprehensive quality management process on compliance with protocol in an emergency medical dispatch center

Ann Emerg Med. 1998 Nov;32(5):578-84. doi: 10.1016/s0196-0644(98)70036-8.


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.

MeSH terms

  • Emergency Medical Service Communication Systems / organization & administration*
  • Employee Performance Appraisal
  • Guideline Adherence*
  • Health Education
  • Humans
  • Total Quality Management*