Synchronize timepieces in your trauma room
Timepieces are probably inaccurate in your ED, which can result in serious problems, both medically and legally, warns Joseph P. Ornato, MD, FACC, FACEP, professor and chairman of the department of emergency medicine at the Medical College of Virginia Hospitals in Richmond.
Research has demonstrated that ED timepieces often are inaccurate and result in poor documentation.1 "As a result, the documentation from a critical event [such as major trauma resuscitation or cardiac arrest resuscitation] will contain inaccuracies, which can have devastating effects," says Ornato, the principal investigator for a study examining timepieces in the ED.
Resuscitation emergencies usually involve many time pieces and many events in a short time period; inaccuracies make it impossible to reconstruct the order of events accurately, he says. Such flaws in the data might make it difficult to reconstruct the events later. "Or worse yet, flaws can make it appear as though certain actions were delayed or done out of the normal sequence. This creates both medical and medicolegal problems," he explains.
He offers this example: A patient is delivered to the ED at an accurate time of 5 p.m., which is documented by the 911 center when the paramedics call in to say they are at the hospital. "If the patient is in ventricular fibrillation, and the physician shocks the patient in the first 30 seconds after arrival, but the nurse documents the time as 5:05, it medicolegally and medically looks like there was an uncalled-for delay in defibrillation."
Staff can be instructed to synchronize their timepieces by calling the number that announces the atomic clock time every 10 seconds, he advises. "But ideally, all clocks should be set universally by a central server." Computers can be programmed to dial and download the correct time automatically into their timepieces from the atomic clock on a daily basis, Ornato notes.
Synchronization to the atomic clock can reduce the problem significantly, he says. "How ever, our study showed that the effects of a one-time attempted synchronization event are short-lived. A continuous program is needed." A continuous program must include periodic synchronization of all timepieces to the atomic clock; ideally, that should be done daily, but monthly updates are more feasible and practical. In addition, a log book should record how far off each timepiece is each month, he advises. "That way, anyone could retrospectively on a given call determine how much maximum error existed in documenting a specific event."
Reference
1. Ornato JP, Doctor ML, Harbour LF, et al. Synchronization of timepieces to the atomic clock in an urban emergency medical services system. Ann Emerg Med 1998; 31:483-487.
For additional information about synchronization of timepieces, contact:
• Joseph P. Ornato, MD, FACC, FACEP, Department of Emergency Medicine, Medical College of Virginia Hospitals, Main Hospital, G 503, 401 N. 12th St., P.O. Box 980401, Richmond, VA 23298. Telephone: (804) 828-4859. Fax: (804) 828-4686. E-mail: ornato@ aol.com.
For an announcement of the current atomic clock time, contact:
• Time Service Department, United States Naval Observatory, Washington, DC. Telephone: (202) 762-1401.
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