Information Transmission and Reciprocity

[Bieber]

So, we often talk about data transmission in EMS. In fact, improving EMS information transmission has become its own dedicated field in the EMS realm with entire businesses dedicated to creating newer and better software for the sharing of EMS information with hospitals.

What we don't talk about often, though, is reciprocity from local hospitals. I don't know about your guys' system, but in mine our ePCRs all get sent over to the receiving hospitals within 24 hours of the patient handoff. The medical providers in the hospital receive our full documentation; our assessment of the patient's home, their HPI as reported on scene, initial vitals and exam findings, and our impression. This information is used to paint a picture and aid in diagnosis and maintain the continuum of patient care.

EMS, in return, gets... nothing. If we bug them, we can get a face sheet so we can input the patient's hospital ID number, along with any billing information we might not have been able to obtain on the call. If we call the ER and speak to the nurse who took the handoff, we can find out what the ER did for them. And if we really want to, we can bug our clinical coordinator to hunt down the eventual fate of the patient if they were admitted. Otherwise, once the patient handover occurs, they're gone. What becomes of them could be anyone's guess. Same for their eventual physician diagnosis and treatment.

This presents a major problem for us in EMS. And one that has probably contributed to the massive amount of poor clinical practice in EMS for so long. We have absolutely no idea (much of the time) what becomes of our patients! Was our diagnosis right? Were our treatments continued or was a different treatment route taken? Was there something found at the hospital that we either didn't check for or which wasn't present at the time of our exam that was crucial to the correct diagnosis?

We can't improve until we've identified the problem, and right now we have very little idea of where we really stand in EMS with regards to our efficacy, accuracy, and the soundness of our treatment decisions. Without that necessary feedback, we have no idea if our diagnosis and treatment is correct 80% of the time or 10% of the time.

So! The solution to this problem is simple, though I have the feeling that the actual implementation of it will pose a much bigger challenge. We need feedback from the hospitals. We need to know what the eventual diagnosis of our patients is, and what treatments were administered in the hospital.

What I want to talk about in this thread is this: what sort of system does your service have for QA/QI for routine and non-routine calls? How do you get feedback from the hospital on your patient care? Do you regularly get feedback from the hospital? Is your service trying to implement a system where you will get regular feedback on all (or the majority of) patient encounters? And if so, how do you take that information and utilize it to improve patient care service-wide or on the individual provider level? And finally, what are the challenges to implementing a system where EMS sends their patient report and gets another one back from the hospital?

Thanks,

-Bieber

[Just Plain Ruff]

What your system needs is a liaison with the receiving hospitals. I know of one person who is a good friend who was specifically hired at a consortium of 8 hospitals to be a EMS to ER to EMS liaison. Her main job is to interface with the local and far out EMS Systems and provide them info on the patient.

I know that in Wichita you have at least two hospitals and the biggest hospital of those would be the best place to start. You've always wanted to expand your skill set and repertiore, why don't you promote that type of position in your department.

Michael

[tcripp]

What I want to talk about in this thread is this: what sort of system does your service have for QA/QI for routine and non-routine calls? How do you get feedback from the hospital on your patient care? Do you regularly get feedback from the hospital? Is your service trying to implement a system where you will get regular feedback on all (or the majority of) patient encounters? And if so, how do you take that information and utilize it to improve patient care service-wide or on the individual provider level? And finally, what are the challenges to implementing a system where EMS sends their patient report and gets another one back from the hospital?

I totally agree that it would be wonderful if we could get good, timely information back from the hospitals. I am fairly pleased to say that for our local facilities, we can get decent feedback (but we have to call) if we catch the right person on a good day. Sometimes, we aren't so lucky. Most of the time, though, I will ask permission from the receiving nurse if I can call later to get an update and dx on the patient. That usually seems to work.

Any patient that is flown gets a call from our assistant director to the hospital for followup - as well as most who go direct to the big city. This helps us to determine the validity of the decision to bypass our local.

[Bieber]

Ruff, that's a great idea, and one I wish we could implement. Unfortunately, with the current budget outlook, adding a position like that is probably not going to happen. But perhaps someone in our clinical department could take on the responsibilities of such a position.

Tcripp, is the hospital diagnosis and treatment (and how similar your own diagnosis and treatment were compared to theirs) ever used as a clinical aid for improving patient care in the future? You said your assistant director follows up on all flights, but is the information being learned from these interactions being applied throughout the system to improve patient care? It sounds like you're pretty much in the same boat we are.

[tcripp]

Tcripp, is the hospital diagnosis and treatment (and how similar your own diagnosis and treatment were compared to theirs) ever used as a clinical aid for improving patient care in the future? You said your assistant director follows up on all flights, but is the information being learned from these interactions being applied throughout the system to improve patient care? It sounds like you're pretty much in the same boat we are.

Occasionally, we will see interesting cases show up during group call reviews for just that. When my old captain was still around, she would bring those types of cases and run scenarios with each of her crews so we could learn from others. Today, not so much. My lessons learned are just mine. I miss the old days...