Administration and Leadership, Columns, Commentary, Patient Care

How Frequently do EMS Providers Receive Feedback on their Care?

Issue 6 and Volume 43.

 

The Research

Cash RE, Crowe RP, Rodriguez SA, et al. Disparities in feedback provision to emergency medical services professionals. Emergency Care. 2017;21:773–781.

The Science

This study comes from data obtained through the National Registry of EMT’s LEADS project.

A survey was delivered with the registration packet for EMTs and paramedics. The objective was to determine how frequently EMS providers are given feedback on their care, the type of feedback received and how they received it.

A total of 15,766 surveys were reviewed, with 69.4% of respondents reported receiving some form of feedback in the 30 days preceding the survey, 54.7% receiving specific feedback on the medical care they provided.

Receiving feedback occurred more often for paramedics, EMS providers with fewer years of service, those that worked for hospital- based agencies, air medical services, and those with higher weekly call volumes.

Feedback was most commonly provided verbally (94.8%) followed by email (35.1%), written (18.5%), and text message (16.3%).

Feedback was received most commonly from a partner or crew member (70.9%), supervisor (59.6%), receiving facility staff (57.4%), and quality improvement officers (42.6%). The medical director was the least common source of feedback at 20.6%.

The conclusion highlighted the concern that almost one-third of respondents hadn’t received any feedback.

They further noted the significant disparity in sources and modalities used to provide feedback.

Medic Wesley Comments

One of my favorite bosses was a nurse manager in the ED who had a sign in her office that said, “Catch people doing something right.”

Feedback to EMS professionals from peers, hospital staff, and medical directors is the opportunity to let providers know when they do something right.

In my career, there weren’t many times I walked out of work at the end of the day wondering if my care was complete, correct, or all-out wrong.

I’m one of those people who dogged the staff, or my medical directors, for the answer. And I learned from it.

But what about those providers who don’t know what they don’t know? They walk away thinking all’s well, and unless it’s a negative QA contact, they rarely hear otherwise.

Feedback is absolutely essential, not only for improvement, but also to encourage the desire to learn and to develop relationships with the other professionals who receive our patients.

When open communication and closed-loop feedback occurs, it builds knowledge and confidence.

This study suggests that we aren’t doing a great job of mentoring providers.

I’m going to give “props” to Doc Wesley. When providers call at all hours of the day, I have the opportunity to hear his side of the medical control call.

I listen briefly before nodding back off, but my favorite thing to hear is when he says, “What do you think?”

This is usually followed by, “I agree, good decision. Flag it for review and I will look it over and we can talk about it.”

That’s feedback. That’s mentoring, and mentoring is what’s needed to improve patient care.

Doc Wesley Comments

Feedback on patient outcomes and the quality of care is vital to professional development. However, that feedback must come through proper channels and not violate protected health information (PHI).

I wonder how many of these respondents got their feedback like this, “Hey, remember that guy you transported to the hospital with a stroke yesterday? We stopped by the nursing station and looked at his chart and he did have a stroke. Looks like it was a bad one, and the family is making him comfort care only. But hey, the nurses said you did a great job!”

There are rules to be followed and processes in place to obtain this type of information.

Once you drop a patient off and submit your run sheet, you have no legal authority to examine their medical record or ask someone else to do so.

Hospitals have received significant fines and sanctions for violating PHI.

I worry about how much information was communicated in the email and text messages that provided their feedback.

I get it; we need to give feedback, but we need to be sure we’re doing it correctly.

The fact that the medical director was the least most common source of feedback is probably a reflection of the fact that physicians are well-versed in what they can and can’t disclose under the peer review statute.

I and my QA specialist have a separate email template that specifically states the material contained is confidential and being provided in accordance with state statute.

And finally, the “props” go to Medic Wesley for her endless support and patience.