eQuality

How well do you do your job?

I’m glad nobody asked me that when I was in the field; I wouldn’t have known how to answer. The best I could have done was quote my IV or intubation success rate, or the number of calls I’d answered, or maybe my average response time, with a little help from someone tracking the migratory habits of ambulances. Put that all together, and I might have offered this self-assessment:

I usually arrive on scene within the arbitrary four-minute target for Calls Not Very Far. I establish 0.26 IVs and 0.01 ETTs per patient and often reach a hospital within the arbitrary 19-minute goal for Patients Not Very Sick.

Hmmm…not exactly a definitive look at my performance, unless we’re playing EMS for Xbox.

How well do we do our jobs? I don’t know. Chances are, neither do you. Maybe we should fix that before our patients find out.

The concept of quantifying success is hardly unique to EMS. To the contrary, statistics in some fields get lots of attention; baseball, for example. Give me a few minutes, and I could tell you how many walks were issued to right-handed batters at Fenway Park in 2013. I’m not sure why you’d want to know that, but it’s available online. The major leagues pay people to track those things partly because facts and figures are popular on a recreational level. Look at Ripley’s or Guinness.

In essential services like EMS, where performance determines patients’ health or even survival, providers should know—should want to know—how they’re doing. Most of us don’t know. Some of us would rather not know; if we knew, so would others, and then we might be held accountable for the quality of our core service, patient care.

I’m fine with that, but we have to define quality of care before we can measure it. My dictionary calls quality the degree of excellence which a thing possesses. To me, excellent care is appropriate care, i.e., treating patients for the right conditions, correctly.

Appropriate care seems a lot harder to measure than response times or IVs, doesn’t it? Where do we begin? Do we need numbers? Can we define criteria for good versus not-so-good care, other than knowing it when we see it?

Let’s start with Assumption #1: Doctors know best. I know that’s not always true, but as a general rule physicians are better at diagnosing our patients than we are—a benefit of studying medicine at post-graduate levels, and of apprenticeships lasting years instead of weeks. (Memo to my fellow paramedics: Try slow, deep breaths before e-mailing me about dermatologists in the field.)

Based on my first assumption, we’d learn a lot about our quality of care if we had a systematic way of comparing doctors’ diagnoses to our own, so cue Assumption #2: Hospitals are the most timely, least inconvenient sources of doctors’ diagnoses for emergent patients. I say least inconvenient because although we have plenty of contact with receiving hospitals, many of them are reluctant to share data. That’s where the folks at Medmerge Solutions can help. I’m not in the habit of recommending products or services in this space, but Medmerge specializes in delivering secure, HIPAA-compliant physician feedback to EMS—something we should all want.

“We’ve been beating this drum for more than three years now,” says Glenn Garwood, managing partner at Medmerge. “Our intent is to change the way hospitals and EMS providers work together by giving paramedics access to clinical outcomes in real time, electronically.”

Medmerge Solutions’ medical director, Dr. David Bauer, says it’s a shock for some EMS agencies to learn HIPAA permits sharing clinical data. “Hospitals typically aren’t willing to give EMS any access to patient records,” he says, “but we have two law firms telling us it’s allowed as part of a formalized QA/QI process.”

Quality assurance/quality improvement requires an organizational commitment—not only to discover sources of substandard performance, but also to verify quality improvement through procedural enhancements.

“You have to follow up on outcomes to evaluate how you got there,” Bauer reasons, and adds Medmerge’s system is the perfect vehicle for a QA/QI tool known as PET (Prehospital Evaluation Technique), a methodical comparison of hospital diagnoses and prehospital care. Such feedback, customized for individual practitioners, can lead to systemwide improvements in quality of care.

“When you say your agency treats strokes correctly 94% of the time,” says Bauer, “that has some weight behind it.”

How well do you do your job? You should know.

Thanks to the gang at EMTLife.com—especially DEmedic, eventer22, Anjel, Robb and ZombieEMT—for their contributions.

Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World’s editorial advisory board. Contact him at mgr22@prodigy.net.