This is the second article in a series about performance measurement and improvement. Part 1, Key performance Indicators: What to Measure and Why is located here. Future articles will present case studies about specific EMS agencies’ improvement efforts.
This article is a real world scenario based on a fire and emergency services organization that provides service for an affluent suburban county with a population of 750,000 and an annual EMS call volume of over 40,000.
Fire and Emergency Services (FES) started the effort to record, measure, and analyze performance data when they found they couldn’t answer basic questions about their performance, such as:
- What are the ROSC percentages or survival rate?
- What were the response times from initial call to patient contact?
- How are patient outcomes measured?
Using the performance improvement process introduced in the first article in our KPI series, FES looked at the organization’s goals.
They established vision and mission statements, as well as a cultural commitment to performance improvement. They made sure everyone in the organization was aware of what the organization wanted to do, how they could achieve it, and how every member of the organization was necessary in order to meet their goal.
The mission and vision statement were proudly placed in every fire station to remind all members every day why they came to work and how they were expected to perform.
FES started there, and then surveyed the community, asking them what they expected from their organization.
With survey results in hand, FES was ready to move forward with a plan.
Since there are hundreds of different KPIs that could be measured in fire and emergency services organizations, they realized that they needed to start small and select the measures easiest to calculate with the data currently at hand and that would have the most benefit to the community. As the organization becomes more efficient in their processes, more complex measures can be added to the management systems.
The community survey indicated that residents wanted to be reassured that, when they contacted 9-1-1, someone would respond to their call in a timely manner. Based on this survey result and the fact they already had data on hand, FES decided that they would tackle response time as one of the first KPIs.
The other KPIs they decided to address were outcomes of ST-elevation myocardial infarction (STEMI), cerebrovascular accident (CVA), and cardiac arrest patients. These were selected to assure the community that critical patients were being cared for properly.
The first challenge came with the response time KPI. For FES, response time is defined as the time the dispatcher answers the 9-1-1 call to the time that a provider talks to the patient (also called “hello to hello” time).
The information determining the first interval of time – the time the dispatcher answers the call – was stored in a different database than the incident data (CAD database). As part of the process, once it was determined that a 9-1-1 caller needed medical assistance, a new incident record was created in the CAD database, however, the duration of the initial phone call wasn’t attached to that record.
Additionally, FES also encountered challenges with the time on scene interval. FES contracts transport services to two separate private ambulance companies. When a caller needs assistance, FES starts to the scene and simultaneously notifies the appropriate ambulance company of the call.
FES captured the time on scene first, but only if they arrived first. If the assigned private ambulance company arrived first, FES didn’t have that data, as it was stored in a different CAD system managed by the private agencies.
Changes & Results
When FES started to look at the different intervals of response times, it became apparent that their units were responding to calls, on average, 2 minutes and 45 seconds after the call was answered. They determined that the delay was due to the unit not being dispatched until the initial call taker collected the vital information from the caller.
The team discovered that, regardless of the information collected from the caller, FES always sent a BLS fire unit and contacted the private ambulance company for transport. With this information, FES was able to start response immediately upon validation of the incident location. This has reduced the turnout time from 2:45 to 8 seconds.
As FES started to look at the clinical performance of the EMS Staff, it was clear that tasks such as administering aspirin on cardiac calls were being performed but not documented. Once FES analyzed the data, they started to ask provider why it looked like certain tasks weren’t being completed. After discussions with the providers, the team found that the data collection started to improve drastically.
It takes time to build the measurement and analysis culture of an organization and they continue to do that today. The organization now has a daily ‘stand-up’ meeting to review the previous day’s exceptions. The meeting is open to all employees, so that everyone can understand how the tasks they’re asked to perform (e.g., data collection, reporting, etc.) are extremely valuable to the organization and that they are vital components to serving the community.
A Continued Commitment
The work doesn’t stop with collecting one or two KPIs. FES will continue to assess areas of their operations that need improvement, define KPIs that will support that improvement, and measure the data that will allow those KPIs to be calculated.
With this continuous approach to process improvement, FES will be able to continue providing the outstanding fire and emergency services that their community deserves and expects.