EMS Insights from VFIS: Closing the Information Gap
Content sponsored by VFIS, the largest provider of insurance, education and consulting services to emergency service organizations such as fire departments, ambulance and rescue squads.
EMS work can be very rewarding—from saving a 16-year-old athlete from sudden cardiac arrest to delivering a baby in the atrium of an office building. However, one of the biggest frustrations we face when dealing with any complex case—or any call, for that matter—is the lack of follow-up information we receive on the patient’s outcome. We are left with lots of questions. Did they make it? Did we make a difference?
As EMS providers, we are the entry point into healthcare systems for many patients, but we rarely learn what happens to a patient after we deliver them to the hospital. Are they admitted to a unit, sent to surgery, or will we see them in the obituary section of the newspaper? We never know. This also leaves us wondering about our patient care reports (PCRs) and how our initial findings compare to what was found by the attending physician or, even more important, where the opportunities are to improve our assessment and care.
Historically, the opportunity to learn about our patients’ treks through the healthcare system has not been available; however, many emergency service organizations (ESOs) are beginning to integrate their healthcare system’s computer-based record tracking, also known as health data exchange (HDE), into their analysis as part of an overall quality assurance (QA)/quality improvement (QI) process. Hospitals have seen improvements in their patient care as physicians gain access to patients’ records anywhere in their database, allowing for a more comprehensive evaluation of past medical history. Sharing this data between the hospital and EMS allows emergency responders to perform comparative analysis of patient information and helps create operational efficiency, measure treatment and improve patient outcomes.
Using HDE data as a part of an overall QA/QI process may seem overwhelming for many ESO administrators at first. A great starting point is a graphical view of overall performance to show general opportunities for improvement. Depending on the level of data collected and the system being used, ESOs may also be able to view performance by quarter, month, week, day or even hour, and some systems also allow access to provider-level data. Note that if a system allows for analysis at the patient level, care must be taken to protect the patient’s identity in accordance with HIPAA regulations.
Track Outcomes and Work Backward
Scott Dorsey, deputy chief of EMS for Snohomish County Fire District 7 in Washington, shared what his region is doing with electronic health records. District 7 is part of a network that is incorporating record management software from ESO Solutions.
Dorsey explains that with this technology, district leaders can track their patients’ outcomes and work backward, from the hospitals’ final diagnoses and treatments to their providers’ first impressions. For example, one paramedic assessed a patient for acute myocardial infarction (AMI) and treated the patient with aspirin, IV therapy and 12-lead ECG. However, after the patient was admitted and attended to by hospital staff, their medical records indicated a diagnosis of heart failure and chronic obstructive pulmonary disease (COPD).
Dorsey emphasizes that one of the big learning points for his agency in the early stages of this technology is data quality. On some occasions they find that staff entered the right information, but in the wrong location or vice versa—a point of education and continued learning for personnel.
“HDE is powerful and a continuous improvement process for our staff and, more important, for our patient population,” Dorsey explains. “Having this outcome data available helps us give our providers the feedback they need to make improvement to the care they provide on a day-to-day basis.”
His example is not uncommon. In fact, using ESO Solutions, Dorsey ran a report examining a one-year period and found that during that period providers’ impressions were different than patients’ outcomes 53% of the time.
One of the most common impression mistakes was strokes. Figure 1 displays patients with a final diagnosis of CVA (stroke) who were transported by Snohomish County Fire District 7 and a comparison between the providers’ initial impressions and the final diagnoses. In this case, the providers were correct with their documented impressions only 31% of the time during the 516-day period.
While internal performance is a great way to analyze and compare impressions, another benefit to using these types of databases is that they also allow users to overlay various benchmarks for performance comparison. Figure 2 shows Washington state data overlaid with information from Snohomish County Fire District 7 during the same time frame. Users can observe how their department is performing compared to other organizations in the state and identify learning opportunities on a much larger scale.
While ESOs may not have access to MRIs, CT scans and other tests in the field, they can use software and HDE data to compare, analyze and adjust how they assess and treat patients. With an emphasis on continuing education and training in the emergency service industry, HDE is one way ESOs can learn from previous cases and apply their real-life experiences to future patients. In the long run, this technology can also help EMS personnel become better prehospital care providers and ultimately work to increase their operational efficiency and improve patient outcomes.
Graphics complements of Snohomish County Fire District 7.
Ryan Pietzsch is director of education and training for VFIS, a subsidiary of the Glatfelter Insurance Group. His responsibilities include national coordination and delivery of education and training programs, curriculum development, information analysis and consulting for VFIS. He is an active member of many fire service organizations, including the IAFC, VCOS, NVFC, ISFSI, CFSI National Advisory Committee, and NFPA 1400 series, 1500 series and 1000 technical committees.