Columns, Documentation & Patient Care Reporting

On-Scene EMS Access to Past Medical History May Improve Care

Issue 5 and Volume 41.

PERTINENT HISTORY

Zorab O, Robinson M, Endacott R. Are prehospital treatment or conveyance decisions affected by an ambulance crew’s ability to access a patient’s health information? BMC Emerg Med. 2015;15:26.

Have you ever run a call where you’re trying to gather pertinent medical history and the patient’s family or another medical provider becomes impatient, requesting you “stop asking questions,” and “just get him to the hospital”?

Kudos to Ollie Zorab and his colleagues at the South Western Ambulance Service in the United Kingdom National Health Service for tackling this issue with a bit of science. Their work is critical to laying a foundation for why EMS needs real-time access to protected medical information, just as any other medical professional.

Background: The study’s authors explore how the access and attainment of past medical information and patient history can affect patient care. To do this, they developed a survey to discover how ambulance personnel gain access to information about a patient’s history, what information was most useful, and whether or not improving access to information helps caregivers offer the most appropriate care.

Methods: A two-part questionnaire asked respondents about 1) their experiences accessing patient information, and 2) making decisions about patient management based on four hypothetical patient scenarios. The scenarios were designed to identify if the absence of patient information would alter the caregivers’ clinical decision-making. Likert scale responses were utilized along with free text box data points that allowed additional comments. In other parts of the online survey, drop-down answers with multiple-choice responses were used.

Results: The online survey was available for on-duty crews for 31 days. During this time, 285 U.K. clinicians (a 12% response rate of clinicians queried) completed both parts of the survey.

Contacting primary caregivers while on scene is routine in this part of England. Nevertheless, the majority of respondents (94%) felt they’d been unable to access health information about their patients, and 90% of respondents felt the lack of information had led to less appropriate care pathways. Most (81%) respondents said it was easier to obtain information during working hours and weekdays. Eighty-six percent of respondents identified a lack of readily available past medical history, and 77% said information on end-of-life issues for resuscitation was unclear. Other aspects of a patient’s medical history that were commonly unavailable to included mental health information, recent ECGs, or summaries from general practitioners or discharge information from other healthcare providers.

The second part of the survey utilized four hypothetical scenarios to understand whether or not increasing amounts of information available to clinicians might lead to more appropriate care.

Inferential statistics revealed relationships between demographic data. Training methods were significantly associated with providers identifying the usefulness of general practitioner summaries and notes. Clinicians with higher education were more likely to report using this information. Older-age clinicians also were found to make sounder referral decisions without information regarding allergies and medications. Finally, the length of time on an ambulance was positively correlated with better care when assessing vital signs and treatment escalation was needed.

Discussion: The two grey-haired authors of this article are very happy to hear that experience on an ambulance improves decision-making. It’s also reassuring that our widely held belief that access to patient health information is critical for safe practice was also reinforced. Improved access to organized and complete data saves time and leads to improved patient safety.

Readers concerned about a 12% response rate on a survey should note how inferential statistics compensates for low response, but should still serve as a reminder that next time we receive a survey from researchers, we should respond! The future of our profession is based on studies such as this and lays the groundwork for EMS to be treated as an equal partner in the chain of healthcare delivery.

Conclusion: As this study shows, ambulance providers can benefit from improved access to patient information. As with all of medicine, and life, making decisions on partial information can have disastrous effects.

BOTTOM LINE

What we already know: The access to patient information and patient history is very important to EMS because when it’s available, providers make better clinical decisions when rendering care.

What this study adds: Finding solutions to accessing a patient’s medical history and information while on scene will improve care and transfer of our patients. The researchers suggest contacting primary caregivers, access to medical information in dispatch centers, and developing easily accessible patient-held records that are always up to date.

GLOSSARY

Inferential statistics: Data that uses computations to make suggestions about an entire population using data drawn from a smaller group.

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