Richmond Ambulance Authority COO Rob Lawrence is a featured speaker at EMS World Expo, September 8–12 in Las Vegas, NV. For more information, visit EMSWorldExpo.com.
Don’t say you don’t have data. Even the most modest, bare-bones EMS operation has numerical information flowing at it constantly: call volumes, response times, patient care reports. The question really is, what are you doing with it?
Hopefully something. It’s the mandate of system leaders—ethically and, increasingly, financially—to absorb that information about their performance and parlay it into better operations and care.
An advanced EMS operation like the Richmond Ambulance Authority (RAA) in Richmond, VA, can collect worlds of data and subject it to sophisticated statistical analysis to dissect performance and measure improvements. But it’s a simple maneuver the service performed with a couple of very basic metrics that really illustrates how data can be used to the advantage of any proactive system.
RAA closely tracks its demand and knows where it comes from and when. It also knows and controls who it has in the field and where they’re posted. By integrating those values, it tailored staffing to demand in a way that lets calls be answered promptly, but without unneeded resources sitting idle.
“We’re a high-performance EMS system, so we deploy the right amount of trucks that our demand says we’ll need,” says RAA’s chief operating officer, Rob Lawrence. “Under other models you might have 20 stations with 20 24-hour shifts going on, no matter what the demand is doing."
That’s an inefficiency most jurisdictions can’t afford. Thus EMS systems need to work to identify and occupy that slim margin between over- and under providing.
Minute by Minute
Richmond has long utilized dynamic staffing and posting, and thought it was handling things pretty efficiently. Around six years ago, though, with response times dragging, RAA parted ways with its previous service provider and became a self operated Public Utility Model (PUM). A new team, including Lawrence and current Chief Executive Officer Chip Decker, decided to reevaluate and employ evidence- and data-based solutions to every piece and part of service delivery.
“We knew very accurately when our calls were coming in,” says RAA’s QA/QI Manager (Communications) Tom Ludin. "With around 56,000 a year, we have a lot of data points that we broke into minute-by-minute segments, determining how many calls are active during each minute, then crunched to calculate how many we could expect in that same minute segment of future dates." Armed with that level of activity intelligence, RAA tweaked staffing accordingly to more closely reflect minute-by-minute demand.
The resulting improvements were the result of fairly simple statistical analysis, uncoupled from any particular product or platform used to gather the data. And that means virtually any service could do something similar.
“This data came from the most basic possible source,” notes Ludin. “We used the time 9-1-1 was activated and the time the ambulance cleared. That’s really just two date and time values. The beginning point is extremely basic, but if you stack up millions of those data points, those start and end times, you can glean all sorts of information from it.”
Richmond has taken a similarly aggressive stance with regard to data in other areas. It tracks unit-hour utilization to make sure it’s operating efficiently. It’s created an alerting system for hospital drop-off delays and also for quick turnarounds. Triggers let RAA immediately review the use of important drugs. If something’s missing on a call sheet, crews can be alerted promptly, resulting in fewer omissions, faster billing and less crews being held over (and the associated overtime that goes with it). Vigilant QA/QI processes monitor all aspects of operations for appropriateness and efficiency.
“If we see we’ve traveled without lights and siren to a STEMI, it needs attention,” says Lawrence. “If we’re on a scene for 45 minutes, we need to understand why so learning can occur if necessary. The advantage of building such a deep data mine is that if you have a question, you can go to the right level of the mine.”
Staffing isn’t the only area where this approach has produced positive results. With the move to ePCRs, RAA was able to look at paramedics’ clinical impressions of patients’ problems, as opposed to just the initial reports of 9-1-1 callers. This led to the discovery that psychiatric issues were one of the biggest reasons RAA were transporting. “That threw us all,” notes Ludin, but helped demonstrate a need for improved care pathways for such patients in the Richmond area. Firm relationships have now formed with RAA being part of intensive case management discussions and solutions.
Best practices for collecting and operationalizing data include having personnel with both statistical and EMS expertise who can pose queries and process answers, and being vigilant that changes are having the desired effects—EMS is a dynamic thing. Think outside the box, too, about things you’d like to know; vendors are happy to work with requests, and for most, customers are part of the creative team.
Beyond that, just know that we don’t know what we don’t know, and questions may arise in the future that we can’t imagine today.
“Collect everything you can possibly get your hands on,” says Ludin. “We’re constantly getting new questions. Just because no one’s asking you today doesn’t mean they won’t tomorrow.”
“Every time we pick up the phone, we record numbers, we record information, we record stats, we record figures,” adds Lawrence. “We have a duty to our patients to do something with that to make sure the next call is more efficient, more effective and more clinically hard-hitting than the last. By taking all those numbers and turning them into intelligence products, we can test, adjust and direct the way we do things today and tomorrow.”