3 Factual Information (as measurements or statistics) used as a basis for reasoning, discussion or calculation
4 EMS Data BP SPO2 Pulse EKG Address Time to Dispatch PMHX Meds EKG Medic Response Time Medicare # Phone # Dispatch Dx Protocol Hospital Drop Time Pain scale 911 Ring ANI/ALI Scene Time UHU Stoke Scale Allergies Bystander CPR
5 EMS Data BP SPO2 Pulse EKG Address Time to Dispatch PMHX Meds EKG Medic Response Time Medicare # Phone # Dispatch Dx Protocol Hospital Drop Time Pain scale 911 Ring ANI/ALI Scene Time UHU Stoke Scale Allergies Bystander CPR Data, Data, Everywhere, But Not a Drop of Information You Can Have Data Without Information – But You Can’t Have Information Without Data - Daniel Keys Moran
Data- Information: Why do we care? Old public model
Data- Information: Why do we care? Old private model
We were the “good guys” “You did the best you could for poor Mrs. Smith.” We were nice…
Where are we headed? “You did your best…. By the way, what percentage of your cardiac arrest patients have return of spontaneous circulation?”
Where are we headed? “You did your best…. By the way, what percentage of your cardiac arrest patients have return of spontaneous circulation?” “How does that compare with other EMS systems your size?”
Who’s asking? City/County governments News media Insurance companies The largest insurer of all….
Evolution and Emergence Healthcare is evolving EMS is evolving More sophisticated More data Data used for metrics Payment for healthcare is evolving Metrics measure quality Quality determines payment
Future of EMS Payment Patient calls 911 Is this a treatable condition? Was the right care given How was the patient experience Did patient get better Pay for quality Value based purchasing model
Problems/Challenges of CQI Size Number of paramedics/calls/protocols Personnel constraints How many calls can be reviewed by hand? Myopic Only looking at protocols and outcomes that you are interested in e.g. cardiac arrest Quality measures tied to reimbursement? 27
Software does the Heavy Lifting Information is pre-sifted and evaluated for key indicators versus pulling information in a reactive way. Data is made available in near real time for analysis and communication with clinicians in timely manner
Human factors Lets people find the problem and in time to correct it! Don’t search..fix
What needs addressing? An individual… Or is it a system issue?
What do we measure today? California Core Measures…. ACS – >35 y/o ASA?Yes/No – 12 lead?Yes/No – Scene time for 12-lead + for STEMI <14:20 – Hospital notified for + STEMIYes/No – Transport to a PCI center for +STEMIYes/No
What does it tell you? Data points not information It’s a starting point not a destination – Does tell you if information is being collected – Gives you an idea if its accurate – Low hanging fruit – At least it’s a start… and gives you a benchmark..
Documentation Quality 34 “If it wasn’t documented, it wasn’t done” Software cannot detect the values of the data that is missing – but it can tell you what data is missing ? Encourages improvements of documentation to get “credit” for what was done.
What is it missing? Our patient care is not yes/no Is it a system issue or an individual problem Can all of the answers to the elements be NO and still have good care?
Patient Outcomes are not Yes and No questions 37 Patient outcomes also need to be measured in similar fashion If the patient had pain, was it managed appropriately? Were there two pain scales done? Were either above x/10? If either were, was pain medication administered? Did the patients pain decrease? If no pain meds, was there a reason? Allergies Patient reluctance Unstable vital signs
Start Small Standard Triggers Response times Turnout times Call processing times Clinical Triggers Patient assessment data Procedures performed Timed criteria
Move Fast Sentinel Alerting – Clinical Missed airways / Missed EtCO2 documentation Medical Director’s “hot buttons” – peds intubations? MERS… – Operational Response times over…20 minutes? Vehicle failures Political “hot buttons”
Add on Protocols - Bundle of care – benchmarking ACS/STEMI Trauma Stroke Respiratory Distress Cardiac Arrest Enhanced Bundle Universal… the elusive 100% QI Billing Behavioral Pain Management… (remember the patient satisfaction metric?)
What's in it for you It’s a tool that helps you do your job with fewer resources More time spent focused on where it needs to be – lets people do the work computers can’t You don’t have to sacrifice a quality program due to budget cuts Real-time feedback on how well your medics are meeting protocols
ROI? Allows the staff they have to see the calls that truly need their attention Efficient use of time and staff Use time to evaluate and improve instead of searching.
Don’t be “this guy”.. Working on what happened last month… “Oh, and some reporter keeps calling for you…”
Thank You! Keep digging, Work smarter, not harder, Change is happening, with us or without us! Questions? For more information…. – www.FirstWatch.net www.FirstWatch.net – Tfitch@firstwatch.net Tfitch@firstwatch.net – Bhorak@firstwatch.net Bhorak@firstwatch.net