Question for EMS Managers - Run Statistics?

[Simusid]

Lets say you are an EMS Manager (General Manager, Operations Manager, QA Manager etc). What would you want to see in a single daily/weekly summary screen in order to get a snapshot of how your service is performing? What is important to you for overall monitoring/management/improvement? Some examples might be:

Average response time/time to call
Average on-scene time broken down by call priority

IV success rate
Tube success rate

Truck miles driven
Overtime hours accrued per period

This kind of summary screen is known as a "dashboard" and can be very useful (if properly designed). I'm trying to design one for my service. All the data comes from our ePCR system. I'm a big fan of "you can't fix it if you can't measure it"

Note - this is intended to be summary statistics over a month or year to identify trends, not individual things like "so and so missed an IV"

 

[WolfmanHarris]

I'm not a manager but if I was I'd like to see:
- a real time operations status including
- available vehicles
- vehicles on a call
- vehicles on offload delay
- crews approaching or past end of shift
- crews awaiting their meal breaks
- snap shot of the day's unit hour utilization including differentiating between available but at a standby post and available in their coverage area.

 

[mgr22]

What I'm not seeing in your examples is quality-of-care measurement. It's not as easy as tracking response times or procedure success rates, but I think it's more important. The idea is to compare prehospital impressions to prehospital care to hospital diagnoses. You won't find much of that being done.

 

[Simusid]

What I'm not seeing in your examples is quality-of-care measurement. It's not as easy as tracking response times or procedure success rates, but I think it's more important. The idea is to compare prehospital impressions to prehospital care to hospital diagnoses. You won't find much of that being done.

I agree, but I don't know how to close that loop. Example: Dispatched for "Altered Mental Status", pt chief complaint is "confusion", clinical impression is "CVA". I would *love* to find out that this (fictitious) patient actually had a glucose of 24 and the medic forgot to take the reading. We occasionally can push for followup information but it is not part of our regular PCR.

 

[EMT John]

I agree, but I don't know how to close that loop. Example: Dispatched for "Altered Mental Status", pt chief complaint is "confusion", clinical impression is "CVA". I would *love* to find out that this (fictitious) patient actually had a glucose of 24 and the medic forgot to take the reading. We occasionally can push for followup information but it is not part of our regular PCR.

That's going to be more of a CES type issue. Your not going to get that from a ePCR. That's all going to part of doing run reviews

The problem with looking at stats like IV attempts and ET tube attempts are the people filling out the PCR's I have had to many people lie about how many times they stuck a pt. I know people are going to say that's falsifying a PCR but unfortenently that's what's going on out there. So getting reports that have those stats I think is a waist of time until those issues get resolved. So personally I would want to see things that people can't lie about.
- all your times
- resource levels
- budget
Things like that. I haven't seen your system so I don't know your options for a dash.

 

[mgr22]

I agree, but I don't know how to close that loop. Example: Dispatched for "Altered Mental Status", pt chief complaint is "confusion", clinical impression is "CVA". I would *love* to find out that this (fictitious) patient actually had a glucose of 24 and the medic forgot to take the reading. We occasionally can push for followup information but it is not part of our regular PCR.

You'd need cooperation from receiving hospitals to compare prehospital care to ED diagnoses. There's precedent for that. Implementing such a program takes effort and commitment. If you're interested in pursuing it, email me at mgr22@prodigy.net and I'll send you some literature.

 

[medicsb]

As mentioned, tracking first attempt success for interventions may be confounded by documentation and bias of the intubator. However, I think that tracking overall success would be more reliable.

As far as getting diagnoses from the recieving hospital, one should be careful to get as precise of a diagnosis as possible. In NJ, all MICUs are required to get the ED diagnosis and disposition (home, tele, ICU, etc.). However the diagnosis received often didn't help. For example, you intubate someone in respiratory failure that you suspect is due to pneumonia and the follow up states "Dx: respiratory failure; recieving unit: ICU".

Where I previously worked, all procedures were tracked. They also monitored things like ASA administration, pain management, 12 leads on women, STEMIs, etc. They also tracked what happened to patients triaged to BLS.

 

[abckidsmom]

Lets say you are an EMS Manager (General Manager, Operations Manager, QA Manager etc). What would you want to see in a single daily/weekly summary screen in order to get a snapshot of how your service is performing? What is important to you for overall monitoring/management/improvement? Some examples might be:

Average response time/time to call
Average on-scene time broken down by call priority

IV success rate
Tube success rate

Truck miles driven
Overtime hours accrued per period

This kind of summary screen is known as a "dashboard" and can be very useful (if properly designed). I'm trying to design one for my service. All the data comes from our ePCR system. I'm a big fan of "you can't fix it if you can't measure it"

Note - this is intended to be summary statistics over a month or year to identify trends, not individual things like "so and so missed an IV"

I'm not a manager but if I was I'd like to see:
- a real time operations status including
- available vehicles
- vehicles on a call
- vehicles on offload delay
- crews approaching or past end of shift
- crews awaiting their meal breaks
- snap shot of the day's unit hour utilization including differentiating between available but at a standby post and available in their coverage area.

Judging by the two lists here, I think you are crossing the line between clinical QA and system performance. It is important to manage both, but Wolfman's list is best assessed through the CAD, IMO. Or a bridge to the CAD.

For clinical QA, I want the system to auto-flag calls of a set acuity, or with keywords checked that we are watching. It would be neat if it was one click from this dashboard to the PPCR.

I also want to know system averages on scene time, drop times, and returning from facility times.

If you're looking to market something, you'll need to customize it. I work in a low-performance EMS-based fire service with 35-60 minute transport times (really, the UHU is sometimes under 0.05). If they asked me, my priority would be on getting medics who don't necessarily feel the urgency of getting back in service. Clear time to available in county is at least 20 minutes.

 

[Simusid]

Judging by the two lists here, I think you are crossing the line between clinical QA and system performance. It is important to manage both, but Wolfman's list is best assessed through the CAD, IMO. Or a bridge to the CAD.

For clinical QA, I want the system to auto-flag calls of a set acuity, or with keywords checked that we are watching. It would be neat if it was one click from this dashboard to the PPCR.

I also want to know system averages on scene time, drop times, and returning from facility times.

If you're looking to market something, you'll need to customize it. I work in a low-performance EMS-based fire service with 35-60 minute transport times (really, the UHU is sometimes under 0.05). If they asked me, my priority would be on getting medics who don't necessarily feel the urgency of getting back in service. Clear time to available in county is at least 20 minutes.

Your keyword suggestion is a great one. I had not considered that. Also, I had made a mental note to myself to include clear time statistics, but it got stuffed in a mental corner and covered with cobwebs. I'll make sure that gets done. We have a dynamic mix of skills on calls. I'm going to also have a manpower report that scores the number of senior medics, staff medics, junior medics and Intermediates/basics on each call. Yes I will have links on the dashboard to individual PCRs.

I've been working on a way to statistically identify new frequent flyers too.

I'm probably not looking to market this because the backend ePCR system, is probably not very well known nationwide. It's a great locally developed product called AmbuPro. I'm really just tinkering around to give our managers another tool.