Case Studies: How the Power of Data Can Transform EMS

Nick Nudell, along with Todd Stout, will present "How to Use Data in Your CAD and ePCR to Improve Operational and Clinical Performance" at EMS World Expo, Sept. 8–12 in Las Vegas, NV. Register today: EMSWorldExpo.com.

One thing missing for many EMS practitioners is clear examples of how their efforts to collect high-quality data can be used to improve patient care or better manage operations. For many EMS managers what’s missing is the utility of getting this data in real time to make system changes as situations present themselves, rather than days or weeks later.

Following are three examples of EMS systems that collect and evaluate their data in real time and use it to improve the quality of patient care and ensure their systems operate as efficiently as possible.

One thing these systems have in common is the use of FirstWatch, which allows them to monitor data in real time from a variety of sources: CAD systems, ePCRs, records management systems, public health, even emergency departments and hospitals. When monitoring the data, triggers are designed to look for certain events and save the data for those calls. Some systems receive notifications of such events by e-mail or text message.

A continuous real-time quality improvement system called FirstPass automates the chart review process so that only records meeting specific criteria require further human review. This process feeds a “paramedic report card” that for the first time allows each provider to monitor and manage his or her own quality.

Pain Management

A new clinical measure for Missouri’s St. Charles County Ambulance District is related to pain control for chest pain patients. Among other things, they evaluate all ePCRs for chest pain patients by asking, “Was the patient’s pain decreased upon arrival at the ED?” The results are based on the patient care data paramedics enter into their ePCR system.

How many of your chest pain patients arrive at the ED with less pain than they started with? Systemwide, St. Charles reports 71 of their last 100 patients had less pain. They also know that about 23% of all their patients have some pain, and that less than 2% receive pain medication. This finding is now guiding their clinical and quality improvement initiatives regarding pain management.

A study published in 2002 had similar findings across all patients (not just those with chest pain).¹ Armed with data about their treatment of chest pain patients, paramedics can provide more informed and potentially better care without management intervention.

Narcotic Use

As a well-regarded high-performance EMS system, the Richmond Ambulance Authority is known for using data to manage the operational aspects of its service, such as posting and deployment. It’s also been using real-time clinical data to monitor various aspects of patient care.

Detailed tracking and accountability of controlled substances is a federal requirement and good for patient care. RAA has taken an innovative approach to maintain compliance with federal laws: It has a FirstWatch trigger that lets a supervisor know whenever a medic uses a controlled substance such as morphine, fentanyl, Versed or even Zofran.

By tracking every drug administration, RAA can monitor and evaluate how often different medications are given. When looking at staff, any unusual patterns or paramedics who document they give more than normal will stand out from the rest.

Pain is a common patient complaint in EMS. Proper pain management is an important contributor to overall patient satisfaction. Here’s a sample that clearly demonstrates that not all medics have the same usage rates. The attached graph provides the manager with critical information so that further analysis can be performed to determine if opportunities for pain management are not being realized by some medics or if pain medication is being used too frequently by others. 

Missing ePCR

In a department as large and busy as the San Antonio Fire Department, it can be easy for crews to get busy and not have time to complete all the charts during a shift. To improve compliance, SAFD management tracks in real time the calls that have been dispatched to EMS units and the ePCRs that have been completed. Four hours after each call has been closed out by dispatch, if its ePCR has not been submitted, a field supervisor will be paged to take action to make it possible for the crew to get it completed.

Lessons Learned

What do these examples have in common?

• All use real-time data to make interventions right away rather than waiting until the end of the month or quarter to run a report.
• All use ePCR data entered by EMS practitioners.
• All result in feedback to patient care providers.
• All are relatively simple calculations and easy to validate.

These are stories of how regular EMS agencies use their data to measure and manage the quality of the care they provide. Doing this in real time ensures crews still have calls fresh in mind, with details intact, rather than waiting weeks or months for someone to run a static report.

The data being analyzed is primarily entered by the crews—straight from the source. It would not be possible to reliably perform these same functions without the ePCR data. Having a standard, relatively simple approach to documentation via ePCR is critically important. This avoids confusion or concern about how valid measures are and lets providers focus on self-improvement. Feedback directly to crew members lets them self-regulate the quality of their care—a hallmark feature, some would argue, of a true profession.

Reference

1. McLean SA, Maio RF, Domeier RM. The epidemiology of pain in the prehospital setting. Prehosp Emerg Care, 2002 Oct–Dec; 6(4): 402–5.

Before joining FirstWatch in 2011 as its systems integration manager, Nick Nudell, MS, NRP, served as the regional operations manager for the Idaho State EMS Bureau, as well as an EMS specialist with the San Francisco EMS Agency. A nationally recognized expert on data and business information, Nick serves on the National EMS Advisory Council, providing advice on EMS issues to the federal government.