When implementing an electronic patient care record, clinical documentation is always the first thing leaders consider, and for some it may be the only consideration. As a hospital-based neonatal and pediatric critical care transport team, we needed the ease of offline field documentation as well as the clinical complexity of ICU level care and access to inpatient records. However, it was also vital that we have the ability to report and analyze data for both quality and research purposes. Once ImageTrend Elite was implemented as our ePCR, we began to fully utilize Report Writer. We built daily, weekly, and monthly reports that drive our quality program, as well as volume reporting and projections. With robust data reporting, the possibility of a retrospective study became possible.
Growth & Planning
As our organization’s call volume increased substantially, we were planning a programmatic expansion and wanted to move from a two-nurse model to a Registered Nurse/Paramedic team. Anecdotally we knew this was a good move; each profession’s specialized training brings complementary strengths to the environment. However, we were also acutely aware that decisions and outcomes cannot be based on feelings and, fortunately, we had the ability to evaluate the data scientifically.
In 2016, Emily Colyer, RN, BSN, NREMT-P CEN, CFRN, CTRN, CNPT, proposed a research study to evaluate the incidence of adverse events in the transport environment prior to the expansion and compare that with the same data following the implementation of RN-Paramedic teams. With the ability to report mapped data points from patient charts, Colyer could develop reports that provided the raw data she needed to compare. Data points including crew configuration, age, mode of transport, and time of day were easily extracted via Report Writer.
The Process & Results
For sound research, it was imperative to ensure runs were clinically comparable and an acuity scored seemed the logical solution. Through an evidence-based approach, Colyer found a tool that she could use to compare the acuity of runs to ensure the validity of her findings. Again, run information needed to be applied to the tool so each patient could be scored. Retrospective scoring would be a tedious, but necessary endeavor. We were able to create a report with the data points necessary to determine the score; scores were then manually assigned and analyzed for the final project. This analysis of 2406 records resulted in the exclusion of 896 of them. When the researcher noted that the distribution of RN/RN and RN/Paramedic teams was not even, an additional 200 charts were analyzed. The final cohort count was 564 incidents.
The final results of the study confirmed our hypothesis: there was no statistically significant difference in adverse events among RN/RN and RN/Paramedic teams. We knew we were doing the right thing for quality patient care, as well as safety and programmatic volume expansion. The findings of this study will give other programs sound research to aid in evidence-based decision-making related to crew configuration.
Rapid programmatic growth is not unique to our organization’s transport program. Developing and implementing policies and procedures that are consistent with accreditation standards, and enabling the highest quality clinical care and levels of safety for both crews and patients, must be the focus for EMS leaders. The first step involves an effective quality improvement program that can only be driven by data. Following the implementation of ImageTrend, we developed reports for monitoring volume and quality on a daily basis. Every morning, four separate reports are automatically generated related to mode, volume, patient types, and procedures. These reports drive our chart review process and allow us to monitor and trend volume fluctuations from a business standpoint. Additionally, several other unique reports mine and analyze data that is then reported on a monthly scorecard to the Quality and Safety committees as well as organizational leadership.
Colyer’s recent publication related to crew configuration research has developed an expanded interest related to the possibilities of focused research. While we are confident in the quality of data that is being collected and reported, her research required a fair amount of labor hours, especially related to acuity scoring. Since the completion of that project, we have implemented an acuity scoring in the form of a Power Tool™ within the documentation itself. This score assignment will allow leadership to track not only mode and volume but also easily track acuity. Additionally, as studies are developed and implemented moving forward, the data necessary to ensure validity will already be a part of the record.
Programmatic expansion has not been specific to volume alone. Our program has changed how we do neonatal transports and we recently started a tiered response program. Among many other things, these changes present the need for robust quality review as well as the opportunities for further research. Our experience with Cloyer’s research taught us the importance of data that is easily reportable, while still being reflective of patient care. Another research study was just launched and will likely utilize a sedation scoring tool that can be created in Elite and reported via Report Writer.
Quality management is a relatively new in the EMS profession. A quality improvement process that allows for reportable documentation is important; being able to trend and analyze this information allows for high quality patient care. In turn, programs that have the ability to produce this kind of valuable information should feel an obligation to critically analyze and share it for the benefit of the profession of EMS and the patients we serve.
Editor’s Note: Megan Sorensen is a finalist for the 2018 Hooley Award in the Service category. The Innovation, Service and New Frontier Hooley Awards will be presented at ImageTrend Connect on July 18th.