Evaluating the impact of an educational intervention on documentation of decision-making capacity in an emergency medical services system.
OBJECTIVE
To compare the documentation of decision-making capacity by advanced life support (ALS) providers and signature acquisition before, one month after, and one year after an educational intervention.


METHODS
The intervention comprised a one-and-a-half-hour module on assessment and documentation of decision-making capacity. Ambulance call reports were reviewed for all ALS calls occurring during three two-month periods, and refusals of transport were recorded. Provider compliance with documentation of decision-making capacity and signature acquisition were determined from a convenience sample of 75 reports from each period. Reviewers were blinded to study period. Twenty-percent double data entry was undertaken to evaluate accuracy. Ninety-five percent confidence intervals were calculated to compare frequencies of cancelled calls and documentation.


RESULTS
From the emergency medical services database, 7,744 calls before the intervention, 7,444 immediately after, and 7,604 one year later were identified. Documentation rates in the second and third periods did not differ from that prior to the intervention (1.3% vs. 0.0% and 0.0% in subsequent periods), nor did the rates of signature acquisition differ (85.3% vs. 85.3% and 78.6%). The accuracy of data entry was 92.6%. However, the frequency of call refusals decreased significantly after the intervention (from 9.0% to 2.0% and 6.6% in the respective periods).


CONCLUSIONS
An educational intervention resulted in no change in the rate of decision-making capacity documentation or signature acquisition by ALS providers for refusal of transport. There was a temporary increase in the number of transported patients.
Riley
Jennifer
J
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. jennifer.riley@utoronto.ca
Burgess
Rob
R
Schwartz
Brian
B
D032962:Consent Forms / Q000706:statistics & numerical data*; D004282:Documentation / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D004634:Emergency Medical Technicians / Q000193:education* / Q000706:statistics & numerical data; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D009864:Ontario; D015397:Program Evaluation; D011446:Prospective Studies; D016312:Treatment Refusal / Q000706:statistics & numerical data