Analysis of base station morphine orders: Assessment of supervising physician consistency

Jerris R. Hedges, John M. Heiser, Keith W. Neely, Robert Norton

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Paramedic contact with a base station should gemerate consistent recommendations reflecting a consensus of base station physician care. In our urban EMS system, paramedics must contact a single base station to provide morphine sulfate (MS) for a patient with chest pain. We performed a retrospective cohort analysis of all prehospital MS requests for chest pain to determine the consistency of the circumstances for which the paramedic team was refused MS. These MS requests represented 123 of the 1,715 (7%) on-line physician consultations during the 6-month study. Only 15 of the 123 (12%) MS requests were refused. Neither the mean patient age, sex distribution, or presenting vital signs correlated with MS refusal. A maximum estimate of transport time to the hospital of ≤5 minutes was noted for 7 of 15 (47%) medication refusals compared to only 11 of 96 (11%) approvals with documented estimated transport times (P ≤ 0.005). A simultaneous request for nitroglycerin (NTG) was noted for 6 of the 15 (40%) medication refusals and 15 of the 108 (14%) approvals (P <0.05). We found refusal of MS administration to be uncommon. Supervising physicians tended to refuse MS when the transport time was short and when NTG was requested for concomitant administration. We also noted physician inconsistencies in refusal scenarios. These findings can guide physician consensus development to avoid sending mixed messages to paramedics.

Original languageEnglish (US)
Pages (from-to)587-590
Number of pages4
JournalJournal of Emergency Medicine
Volume8
Issue number5
DOIs
StatePublished - 1990

Fingerprint

Morphine
Physicians
Allied Health Personnel
Nitroglycerin
Chest Pain
Consensus
Sex Distribution
Vital Signs
Age Distribution
Cohort Studies
Referral and Consultation

Keywords

  • administration
  • base station
  • emergency medical services (EMS)
  • on-line medical control
  • paramedic practice
  • physician orders
  • prehospital care

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Analysis of base station morphine orders : Assessment of supervising physician consistency. / Hedges, Jerris R.; Heiser, John M.; Neely, Keith W.; Norton, Robert.

In: Journal of Emergency Medicine, Vol. 8, No. 5, 1990, p. 587-590.

Research output: Contribution to journalArticle

Hedges, Jerris R. ; Heiser, John M. ; Neely, Keith W. ; Norton, Robert. / Analysis of base station morphine orders : Assessment of supervising physician consistency. In: Journal of Emergency Medicine. 1990 ; Vol. 8, No. 5. pp. 587-590.
@article{91d8f6bcb982448bb99460d5605e9d31,
title = "Analysis of base station morphine orders: Assessment of supervising physician consistency",
abstract = "Paramedic contact with a base station should gemerate consistent recommendations reflecting a consensus of base station physician care. In our urban EMS system, paramedics must contact a single base station to provide morphine sulfate (MS) for a patient with chest pain. We performed a retrospective cohort analysis of all prehospital MS requests for chest pain to determine the consistency of the circumstances for which the paramedic team was refused MS. These MS requests represented 123 of the 1,715 (7{\%}) on-line physician consultations during the 6-month study. Only 15 of the 123 (12{\%}) MS requests were refused. Neither the mean patient age, sex distribution, or presenting vital signs correlated with MS refusal. A maximum estimate of transport time to the hospital of ≤5 minutes was noted for 7 of 15 (47{\%}) medication refusals compared to only 11 of 96 (11{\%}) approvals with documented estimated transport times (P ≤ 0.005). A simultaneous request for nitroglycerin (NTG) was noted for 6 of the 15 (40{\%}) medication refusals and 15 of the 108 (14{\%}) approvals (P <0.05). We found refusal of MS administration to be uncommon. Supervising physicians tended to refuse MS when the transport time was short and when NTG was requested for concomitant administration. We also noted physician inconsistencies in refusal scenarios. These findings can guide physician consensus development to avoid sending mixed messages to paramedics.",
keywords = "administration, base station, emergency medical services (EMS), on-line medical control, paramedic practice, physician orders, prehospital care",
author = "Hedges, {Jerris R.} and Heiser, {John M.} and Neely, {Keith W.} and Robert Norton",
year = "1990",
doi = "10.1016/0736-4679(90)90455-5",
language = "English (US)",
volume = "8",
pages = "587--590",
journal = "Journal of Emergency Medicine",
issn = "0736-4679",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Analysis of base station morphine orders

T2 - Assessment of supervising physician consistency

AU - Hedges, Jerris R.

AU - Heiser, John M.

AU - Neely, Keith W.

AU - Norton, Robert

PY - 1990

Y1 - 1990

N2 - Paramedic contact with a base station should gemerate consistent recommendations reflecting a consensus of base station physician care. In our urban EMS system, paramedics must contact a single base station to provide morphine sulfate (MS) for a patient with chest pain. We performed a retrospective cohort analysis of all prehospital MS requests for chest pain to determine the consistency of the circumstances for which the paramedic team was refused MS. These MS requests represented 123 of the 1,715 (7%) on-line physician consultations during the 6-month study. Only 15 of the 123 (12%) MS requests were refused. Neither the mean patient age, sex distribution, or presenting vital signs correlated with MS refusal. A maximum estimate of transport time to the hospital of ≤5 minutes was noted for 7 of 15 (47%) medication refusals compared to only 11 of 96 (11%) approvals with documented estimated transport times (P ≤ 0.005). A simultaneous request for nitroglycerin (NTG) was noted for 6 of the 15 (40%) medication refusals and 15 of the 108 (14%) approvals (P <0.05). We found refusal of MS administration to be uncommon. Supervising physicians tended to refuse MS when the transport time was short and when NTG was requested for concomitant administration. We also noted physician inconsistencies in refusal scenarios. These findings can guide physician consensus development to avoid sending mixed messages to paramedics.

AB - Paramedic contact with a base station should gemerate consistent recommendations reflecting a consensus of base station physician care. In our urban EMS system, paramedics must contact a single base station to provide morphine sulfate (MS) for a patient with chest pain. We performed a retrospective cohort analysis of all prehospital MS requests for chest pain to determine the consistency of the circumstances for which the paramedic team was refused MS. These MS requests represented 123 of the 1,715 (7%) on-line physician consultations during the 6-month study. Only 15 of the 123 (12%) MS requests were refused. Neither the mean patient age, sex distribution, or presenting vital signs correlated with MS refusal. A maximum estimate of transport time to the hospital of ≤5 minutes was noted for 7 of 15 (47%) medication refusals compared to only 11 of 96 (11%) approvals with documented estimated transport times (P ≤ 0.005). A simultaneous request for nitroglycerin (NTG) was noted for 6 of the 15 (40%) medication refusals and 15 of the 108 (14%) approvals (P <0.05). We found refusal of MS administration to be uncommon. Supervising physicians tended to refuse MS when the transport time was short and when NTG was requested for concomitant administration. We also noted physician inconsistencies in refusal scenarios. These findings can guide physician consensus development to avoid sending mixed messages to paramedics.

KW - administration

KW - base station

KW - emergency medical services (EMS)

KW - on-line medical control

KW - paramedic practice

KW - physician orders

KW - prehospital care

UR - http://www.scopus.com/inward/record.url?scp=0025065059&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025065059&partnerID=8YFLogxK

U2 - 10.1016/0736-4679(90)90455-5

DO - 10.1016/0736-4679(90)90455-5

M3 - Article

C2 - 2254607

AN - SCOPUS:0025065059

VL - 8

SP - 587

EP - 590

JO - Journal of Emergency Medicine

JF - Journal of Emergency Medicine

SN - 0736-4679

IS - 5

ER -