Exclusives, Operations, Top Story

Using Benchmark Data as a Launching Point for Quality Improvement in EMS

EMS agencies strive to provide the best possible care and contribute to positive patient outcomes. To ensure a high level of care, many agencies implement quality improvement programs; choosing a place to start for a quality improvement initiative, however, can seem overwhelming, with so many important conditions like cardiac arrest, sepsis, stroke, overdoses, etc. With limited time and resources, it’s necessary to concentrate efforts on measures that matter and are likely to make an impact.

A great place to start with quality improvement efforts is where the gold standard is known and the frequency of events isn’t rare. For example, how often does your EMS agency encounter patients experiencing chest pain? And, when the call goes out for a 68-year-old male who’s having trouble breathing and he says that he feels like an elephant is sitting on his chest, what do you expect EMS professionals at your agency to do?

Performing a 12-lead ECG is the gold standard for evaluating cardiac ischemia. This key EMS assessment can have a substantial impact on early recognition of ST-elevation myocardial infarction (STEMI), transport to an appropriate facility, activation of the cath lab, and ultimately a successful patient outcome. National efforts like the American Heart Association’s Mission: Lifeline have focused on this measure, and achieving at least 75% compliance on this measure is one of the performance metrics to earn this recognition for EMS.

Let’s say you’re interested in improving your agency’s performance on this metric, so you immediately set to work designing interventions to improve performance. But how will you know if your efforts worked?

To Improve, You Must Measure

Management thinker Peter Drucker is often quoted as saying that, “If you can’t measure it, you can’t improve it.” What this means for quality improvement is that you can’t know whether or not you’ve made a successful change unless you are able to define and track success.

For example, let’s say that improving 12-lead ECG acquisition for patients experiencing chest pain has been identified as a quality improvement priority at your agency. After rolling out an extensive chest pain protocol training over several sessions, the latest report shows that 12-lead ECG acquisition in adult patients who were experiencing chest pain went up by 2%. The question then follows, “up 2% from what?” and, “Is this level good, bad, or somewhere in the middle?”

To answer the first question, establishing clearly defined measures and obtaining baseline data are critical before implementing an improvement intervention. For the second question, knowing how your agency or system’s performance compares to others may be a good place to start.

A National Look at 12-lead ECG Acquisition for Adults Experiencing Chest Pain

First released in 2018, the ESO EMS Index provides objective, data-driven insights around key metrics that EMS agencies encounter frequently. In 2019, the ESO EMS Index was calculated using a data set of 7.58 million patient care records from more than 1,200 EMS agencies across the country covering the previous calendar year (Jan. 1–Dec. 31, 2018).

The data from the 2019 ESO EMS Index show that a 12-lead ECG was performed in 77% of all cases where the EMS provider’s primary impression was documented as nontraumatic chest pain and the patient was 35 years of age or older. This means that either no ECG was performed, or a different type of ECG was performed 23% of the time. When we compare this performance to the previous year, this represents an increase of only 1 percentage point from the 2018 Index (76%).

There are of course limitations to consider, including possible miscategorization, such as when nontraumatic chest pain for patients with a clear non-cardiac etiology are documented under the primary impression for chest pain. Yet, the goal of the Index isn’t to serve as a scientific study, but rather provide an informative and directional discussion surrounding key metrics encountered by EMS.

A stagnant compliance rate of 76–77% with 12-lead acquisition for patients experiencing chest pain over the last two years is non-trivial and may signal an area to target for improvement. EMS agencies can use these numbers to place their organization’s performance into context and help guide decisions related to where to focus quality improvement resources.

In addition to 12-lead ECG for adult patients experiencing chest pain, the 2019 ESO EMS Index includes four other metrics reported in the 2018 Index and two new key population health surveillance measures: influenza-like illness and opioid overdose. The Index serves as a starting point of something real and concrete that EMS agencies can use to compare their performance to that of other agencies.


EMS agencies are constantly striving to do what is best for patients and to improve outcomes. When it comes to quality improvement initiatives, time and financial resources are often constrained and efforts must be prioritized. While every EMS agency is unique and should take into account the strengths and goals of the organization, using benchmarks tightly linked to standards of care can be a useful place to start when deciding where to target quality improvement efforts.

Download the full 2019 ESO EMS Index

Turning Insights into Action: Improve your agency and your community with the 2019 ESO EMS Index
Date: Wed, Feb 27, 2019
Time: 2:00 PM CST (12:00 PM PST)

Join Drs. Brent Myers and Remle Crowe for an exclusive overview and analysis of the 2019 ESO EMS Index. Review the five standing metrics from the Index and be introduced to two new metrics with interesting findings: flu impressions and opioid overdoses. You’ll gain an understanding of national performance and actions your agency can take to improve health and safety in your community. Live webcast attendees will receive continuing education credit; all registrants will receive a PDF copy of the webcast.