It’s the end of a long and difficult resuscitation and you’re drained. The last hour was an onslaught of activity: managing a diverse team of responders, performing CPR, interpreting heart rhythms and providing care. You’re finally sitting down at the hospital, your patient is in critical condition but maintaining a pulse, and your partner is putting your unit back together. Now that your adrenaline levels are receding, you really just want a few minutes of down time. But duty calls. The call isn’t over until you’ve completed your electronic patient care record (ePCR).
After transcribing a few notes jotted on your glove, you enter the last set of vital signs, read over your narrative one last time and hit submit. Your report vanishes, not to be seen or thought of anytime soon-that is, unless your supervisor has a question or you forgot to get the Medicare signature. Again.
But all that information you meticulously entered didn’t just simply disappear. In fact, your ePCR is a critical piece of a puzzle that will help you provide better care and save more lives.
EMS data serves many purposes, not the least of which is allowing us to evaluate how we’re doing-not only on the cardiac arrest you just finished, but on all cardiac arrests in your agency and on the many cardiac arrests across the country. Without basic baseline performance measures, EMS personnel from the field to the corporate office have no way of knowing if they’re meeting the ultimate objective: high-quality, evidence-based patient care.
Uniform Industry-Wide Data
The need for uniform data in the 1980s and early 1990s led to the development of many statewide EMS data systems. However, those systems varied in how they collected the data, what they collected and how they allowed systems to review the data. In 2001, the creation of the National EMS Information System (NEMSIS) set the standard for EMS data collection today. NEMSIS helped states collect standardized elements, which means the way vital signs are collected in Jackson, Miss., is the same way it’s done in Blue Earth, Minn. Today in Version 3, NEMSIS includes over 400 data elements.
In simple terms, NEMSIS created an alphabet so that every ePCR uses the same letters and words to tell the story of the call. It allows us to harness the power of all those records to conduct research at the state and national level to develop evidence-based protocols and study the impact of certain treatments. It also paved the way for EMS Compass, an initiative that’s designing performance measures based on the NEMSIS data definitions and allows ePCR developers to embed those measures into their software, so agencies can easily examine their performance and benchmark it against the rest of the state or nation.
Collect, Analyze, Act
The first step to being able to use everyday data to improve EMS, however, is to recognize the value of accurate data collection.
Michael Arinder, South Region Clinical Services Director for American Medical Response (AMR), said, “Albert Einstein once stated that ‘Insanity is doing the same thing over and over again and expecting different results.’ It’s true. Bad data is medical insanity.”
Accurate data entry is the key to success. Poor data collection makes it challenging to see if what’s done in the field is good patient care or just a good idea. The quality improvement process relies on quality data, quality analysis and accurate interpretation in order to understand, modify and improve field activities (e.g., protocol change). Without reliable information, processes in the field are reduced to speculation.
Precise, complete data entry allowed AMR in Jackson, Miss., to determine where they needed to target CPR outreach education by breaking down bystander CPR data by zip code. “For every cardiac arrest, our field providers collect several data points including bystander CPR prior to arrival and location zip code,” Arinder said. “We began to see a pattern. The areas where we provided CPR/AED outreach education had a high incidence of bystander CPR and a higher survival rate.”
With that knowledge in hand, AMR’s educators began providing CPR education opportunities to the zip codes where bystanders weren’t performing CPR. According to Arinder, survival rates increased in those neighborhoods after the training. Only with accurate reporting in ePCRs and analysis of dispatch and patient information was the agency able to target limited resources at educating the communities that needed it the most-an effort that has saved lives.
Reliable, consistent data is essential. Data needs to be reviewed by running operational and clinical reports on a regular basis. These reports can also show how an agency is performing and what changes may require attention. Services need to ensure compliance even in well-functioning systems. There’s always room for improvement, and always data that can show you where you need to improve.
The second step is to decide how to analyze the data that’s collected. This is done through establishing performance measures to determine if protocols are leading to the right care and if they’re improving patient outcomes.
For example, the 7th edition of PreHospital Trauma Life Support (PHTLS) recommends that EMS providers initiate transport of critically injured trauma patients to the closest appropriate facility within 10 minutes of making patient contact. A service can review its trauma call data to determine if the crews are meeting this benchmark and to evaluate the patient outcome.
Once the data has been collected and analyzed, it’s time to act. This key part of the process allows the medical director, the leadership team and field providers the opportunity to evaluate clinical performance and the protocols and processes that are in place to support quality care.
Back to the Basics
Part of ensuring accurate data is to make sure the patient care documentation is a true representation of the call. Often the first of many documents written about a patient is the EMS run report. The report represents the practices and the interests of the multiple professionals or caregivers engaged in caring for ill or injured patients.
Next to patient care, documentation is one of the most important things done in EMS. It shouldn’t be thought of as something to be done after the call, but a key part of the call itself. Although many of us learned that documentation was critical because it provided a record of patient care read by other caregivers, such as ED staff or by attorneys in case of legal issues surrounding the call, there are also several other reasons why documentation and EMS data are so important.
- Only by looking at what we’ve done can we figure out how we can get better. Data taken from ePCRs and hospital records tells us whether protocol or process changes are doing what they’re supposed to-improving patient care and saving lives.
- Data from ePCRs can be used by researchers to demonstrate the effectiveness of certain medical interventions. For example, ePCRs have been used in studies that have helped determine what ratio and rate of chest compressions are effective and whether inducing hypothermia leads to better outcomes.
- Data can help EMS justify its value. We know we make a big difference to our patients and our communities-but in today’s culture we have to prove it. When the city council wants to know why it’s important to buy a $25,000 cardiac monitor, your service can use the data to show how many times it was used and how many patients were defibrillated.
- Because documentation becomes a part of permanent medical records, it can be used in preparing bills and in submitting records to insurance companies. Complete and accurate documentation helps your agency pay for equipment and other necessary items.
- Electronic records, good documentation and data-driven decision-making will help EMS get the respect it deserves from the larger healthcare community. The people who read our reports may judge us both individually and as a profession based on what we write and the information we provide. Because of this, simple tasks such as using the spell check function on computer reports, looking for and completing all automatic “drop downs” on data fields, and making sure to read the report before submitting can all make a big difference.
Measuring performance through data is critical to propelling prehospital care forward. It allows EMS practitioners to evolve from a trial-and-error system to one based on evidence, continually improving and meeting the ultimate goal of providing the highest quality care to the people we serve.