EMS Leaders Share How They Use Data to Improve EMS Systems
“If we have measures that are truly patient-centered… I believe we’ll make much better decisions and make much more significant improvement,” said Mike Taigman, General Manager of AMR in Ventura County, Calif., and a leading expert in EMS quality improvement, during a webinar sponsored by EMS Compass, the national initiative to develop a system of performance measurement for EMS.
Taigman admitted that measuring patient outcomes is a struggle in EMS and medicine generally. But that doesn’t mean EMS shouldn’t strive to have performance measures that are as patient-centered as possible.
The webinar was one in a series of ten that were held earlier this month by EMS Compass as part of the initiative’s continuing effort to engage and receive input from the EMS Community. Each webinar tackled one of the ten domains of measures that EMS Compass is addressing.
During the session on population and public health, Taigman described the process measures that he believes EMS can use when true patient outcome measures are difficult to assess. A process measure, EMS Compass Project Manager Nick Nudell explained, is one that evaluates a step in the process that is linked to outcomes but is not the outcome itself.
Taigman’s examples included measuring the time from the first 911 call to certain evidence-based procedures for time-sensitive conditions, such as:
· first chest compression for cardiac arrest
· restoration of blood flow for STEMI
· first CT scan interpretation for stroke
· infusion of two liters of fluid for sepsis
There are six domains of measures that correlate to the priorities in the U.S. Department of Health and Human Services National Quality Strategy. Population and public health is one; the other five are patient and family engagement, patient safety, care coordination, efficient use of healthcare resources, and clinical process and effectiveness.
In keeping with the project charter to address all aspects of an EMS system, the initiative added four other domains: workforce, fleet, finance and data.
Noah Smith, with the National Highway Traffic Safety Administration (NHTSA) Office of EMS, which is funding the effort, briefly addressed the webinar audiences, telling them that EMS Compass was the continuation of an effort that began decades ago to standardize the collection of EMS data. Now, with the success of the National EMS Information System (NEMSIS), EMS Compass will help local and state EMS organizations use the data meaningfully “to improve the care of our patients, to prove [EMS makes] a difference, and ultimately to get paid for it,” Smith said.
In the EMS workforce webinar, paramedic and researcher Daniel Patterson, PhD, a senior scientist with the Carolinas Healthcare System in Charlotte, N.C., discussed some of his previous research and how standard definitions could help EMS agencies measure employee turnover and other workforce issues.
“Turnover is costly,” Patterson said, explaining one of many reasons why measuring employee retention and turnover, and being able to compare one’s agency to others, might be useful.
Patterson also discussed ways to measure teammate or partner familiarity, fatigue and the safety culture within an organization—all of which have been linked to safety outcomes by research, he said.
While in the past some of these measures have used questionnaires that can be time-consuming to administer to staff, Patterson and other researchers have been working to refine those surveys to make them shorter but still valid. Other ways of measuring these factors, such as using text messaging to assess fatigue, are currently being investigated.
Mike Ragone, Director of System Design for AMR, spoke about the difference between measuring “on scene” times and “at patient” times during the session on efficient use of healthcare resources. While there is debate over the importance of response time as a clinical measure, there is generally agreement that if time does matter, it is the time to actually get to the patient’s side, not just to park in front of the building.
“On scene time versus at patient side, as we all know, can be a huge difference,” Ragone said, citing the example of responding to a casino where it may take 15 minutes to reach the patient after arriving. “If we do not separate them, we won’t be able to draw conclusions” about the clinical relevance of response times, he added.
Ragone discussed some of the different ways systems are trying to measure accurate at-patient times, from communicating via the radio in order to let dispatchers mark the time to using handheld devices, such as smart phones, that allow the practitioners in the field to accurately record the time.
Although EMS Compass aims to create performance measures around the data standards established by NEMSIS, it was clear that this effort to use data to assess system performance may also drive changes to how data is collected, as EMS systems determine which elements are most critical to analyze.
During the other sessions, several other EMS leaders discussed a range of topics, including:
· Allina Health EMS President Brian LaCroix discussed some of the quality improvement efforts the agency has taken in recent years during the webinar focused on efficient use of healthcare resources.
· Rick Keller, a partner with Fitch & Associates, and Jon Washko, Assistant Vice President, North Shore LIJ Center for EMS, addressed various ways to assess the financial status of an EMS system.
· Todd Stout, founder of FirstWatch Solutions, and Lindsey Narloch, EMS Data Manager for the North Dakota Department of Health and a member of the EMS Compass Steering Committee, joined a session on EMS data, where Narloch discussed the importance of measuring data collection, since it is the backbone of all the other measures.
· Rob Lawrence, Chief Operating Officer of the Richmond Ambulance Authority, and Dwight Brown of the Mayo Clinic discussed how measuring clinical effectiveness can lead to improvements in patient care.
Nudell also discussed the process EMS Compass is using to prioritize, design and test performance measures. During each stage of the process, there will be further opportunities for members of the public to become involved, from providing feedback through the website to participating in field testing of actual performance measures.
For more information about EMS Compass or to volunteer to be involved in the national effort, sign up to receive updates at www.emscompass.org, and follow the initiative on Facebook, LinkedIn and Twitter (@EMSCompass). To view recordings of the webinars, visit emscompass.org/webinars.