Just Like Patients, Your System Needs Assessment

When paramedics encounter a patient, what’s the first thing they do after making sure the scene is safe and isolating body substance? They assess the patient!

We all know the routine: First comes the primary assessment, then the secondary assessment. Performing an assessment is necessary to get a sense of what’s wrong with the patient, and taking additional vital signs throughout the call lets the paramedic know whether the patient’s condition is improving or deteriorating.

Unfortunately, many EMS managers fail to perform assessments on their EMS systems and don’t continue to take vital signs to see how healthy it is.

I’m not talking about a physical assessment, of course–I’m talking about benchmarking and looking at key performance trends in your EMS operation. Using operational benchmarks and trends is no different than looking at the health of a patient and determining their status.

Benchmarking and trending are not exactly the same things, but are used in conjunction with each other. A benchmark is a point of reference from which measurements can be made or a measurement that sets a standard by which other measurements are compared. A trend is a general direction in which something tends to move.

For example, an eight-minute response time for 90% of calls would be a benchmark. Tracking your response time every week or every month for a year to determine if your response times are staying the same, increasing or decreasing is determining the trend.

Taking It Further
Plotting the weekly response times on a graph for a visual display can show if you’re trending up or down with your response time benchmark. If your response time is trending away from the benchmark with longer response times, you can make changes in your system and measure the trend to determine if your strategies are working. Other analysis tools such as linear regression modeling can project trending into the future.

Progressive EMS managers use benchmarks and trending in their strategic planning process. As an example, your medical director may set two benchmarks: that all chest pain patients will have an ECG done within five minutes of arrival, and that a patient will be transported to a percutaneous coronary intervention center at a hospital within 15 minutes of determining the chest pain is an ST elevation myocardial infarction (STEMI).

Progressive EMS managers then set the medical director’s benchmarks as a strategic goal in their planning process and put objectives and action items in place to reach those benchmarks–such as training paramedics in 12-lead ECG STEMI recognition, increasing technology for transmission of 12-leads to the hospital, and training paramedics on the new five- and 15-minute goals.

Once all the objectives and action items listed in the strategic plan to achieve the director’s benchmarks have been met, it’s time to start tracking performance and plotting it on a graph to measure success. You can measure it on a daily, weekly and/or monthly basis to determine if you’re meeting your benchmarks and which way the data is trending. It might take time to achieve compliance, and improvements are not guaranteed. If your benchmarks aren’t achieved or the trending shows non-compliance with the benchmarks, you’ll need to revisit your strategies.

As I mentioned earlier, linear regression modeling can project future trends and whether or not you’ll meet benchmarks. Basically, with linear regression modeling, you don’t have to generate months of data to know if it’s going to work–you merely project the data into the future.

The Process
Benchmarking and mapping trends comes down to a four-phase process. The first phase is to plan; this is when the benchmarks are established and training occurs. The second phase is the data collection phase. During this phase, data is collected and plotted into a graph with trend lines. The third phase is the analysis phase, where you’re essentially analyzing the data and trend lines to determine compliance with the established benchmarks. The final phase is the adaption phase. During this phase you use your successes and failures to make modifications to the plan so benchmarks are met.

Benchmarking and trending are advanced managerial techniques for improving your EMS system and determining your progress. Don’t be one of those EMS managers who just pours over charts and data every day to measure performance. Getting out and talking to your people can also be valuable in helping you determine what is and isn’t working.

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