data – its only a four-letter word if you don’t use it. bernie horak, b.s. emt-p clinical...

Data – Its only a four-letter word if you

don’t use it.

Bernie Horak, B.S. EMT-PClinical SpecialistFirstWatch L.L.C.

What is “Data”

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What is “Data”

3

Factual Information (as measurements or statistics) used as a basis for reasoning,

discussion or calculation

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EMS DataBP

SPO2

PulseEKG

Address

Time to Dispatch

PMHX

Meds

EKG

Medic

Response Time

Medicare #

Phone #Dispatch Dx

Protocol

Hospital

Drop Time

Pain scale

911 Ring

ANI/ALI

Scene Time

UHU

Stoke Scale

Allergies

Bystander CPR

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EMS DataBP

SPO2

PulseEKG

Address

Time to Dispatch

PMHX

Meds

EKG

Medic

Response Time

Medicare #

Phone #Dispatch Dx

Protocol

Hospital

Drop Time

Pain scale

911 Ring

ANI/ALI

Scene Time

UHU

Stoke Scale

Allergies

Bystander CPRData, Data, Everywhere,

But Not a Drop of Information

You Can Have Data Without Information – But You Can’t Have Information Without Data

- Daniel Keys Moran

Data- Information: Why do we care?

• Old public model

Data- Information: Why do we care?

• Old private model

We were the “good guys”

• “You did the best you could for poor Mrs. Smith.”

• We were nice…

Today’s response

Where are we headed?

• “You did your best…. By the way, what percentage of your cardiac arrest patients have return of spontaneous circulation?”

Where are we headed?

• “You did your best…. By the way, what percentage of your cardiac arrest patients have return of spontaneous circulation?”

• “How does that compare with other EMS systems your size?”

Who’s asking?

• City/County governments

• News media• Insurance companies• The largest insurer of all….

Evolution and Emergence

Healthcare is evolvingEMS is evolving

More sophisticatedMore data

Data used for metrics

Payment for healthcare is evolvingMetrics measure quality

Quality determines payment

Future of EMS Payment

• Patient calls 911• Is this a treatable condition?

• Was the right care given • How was the patient experience

• Did patient get better• Pay for quality

Value based purchasing model

Is this very far off?EMS

?

But What’s Possible Without……

And then there were none!!

Traditional Quality Improvement

Labor intensive, time consuming and quite often confusing

Retrospective

Leaves little time to truly monitor and improve care

Lots of Data

Where are your problems?

The One that didn’t follow protocol

Change

The Desired Road Map

• Commitment• Empowerment• QI Infrastructure• Customer Service• Teamwork & Collaboration• Continuous Process

Improvement

Discovery

What are you currently doing today to measure quality improvement?

How do the pieces fit together?

Where do you want to be?

Identify your target

Creating a Culture of Quality

Goals of CQI

• Protocol compliance• Patient outcome• Documentation quality• Paramedic feedback

• “Continuous”

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Problems/Challenges of CQI

•Size Number of paramedics/calls/protocols

•Personnel constraints How many calls can be reviewed by hand?

•Myopic Only looking at protocols and outcomes that you are interested in e.g. cardiac arrest•Quality measures tied to reimbursement?

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Which Road Will You Take?

Software does the Heavy Lifting

• Information is pre-sifted and evaluated for key indicators versus pulling information in a reactive way.

• Data is made available in near real time for analysis and communication with clinicians in timely manner

Human factors

• Lets people find the problem and in time to correct it!

• Don’t search..fix

What needs addressing?

• An individual…

• Or is it a system issue?

What do we measure today?

• California Core Measures….

ACS– >35 y/o ASA?

Yes/No– 12 lead ?

Yes/No– Scene time for 12-lead + for STEMI <14:20– Hospital notified for + STEMI Yes/No– Transport to a PCI center for +STEMI Yes/No

What does it tell you?

• Data points not information• It’s a starting point not a destination

– Does tell you if information is being collected– Gives you an idea if its accurate– Low hanging fruit

– At least it’s a start… and gives you a benchmark..

Documentation Quality

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•“If it wasn’t documented, it wasn’t done”

•Software cannot detect the values of the data that is missing – but it can tell you what data is missing ?

•Encourages improvements of documentation to get “credit” for what was done.

What is it missing?

• Our patient care is not yes/no

• Is it a system issue or an individual problem

• Can all of the answers to the elements be NO and still have good care?

One Customers Methods

Patient Outcomes are not Yes and No questions

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•Patient outcomes also need to be measured in similar fashion • If the patient had pain, was it managed appropriately?

• Were there two pain scales done?• Were either above x/10?• If either were, was pain medication administered?• Did the patients pain decrease?• If no pain meds, was there a reason?

• Allergies• Patient reluctance• Unstable vital signs

Start Small

Standard Triggers • Response times• Turnout times• Call processing times

Clinical Triggers• Patient assessment data• Procedures performed• Timed criteria

Move Fast

• Sentinel Alerting– Clinical

• Missed airways / Missed EtCO2 documentation• Medical Director’s “hot buttons” – peds intubations?• MERS…

– Operational• Response times over…20 minutes?• Vehicle failures• Political “hot buttons”

Add onProtocols - Bundle of care – benchmarking • ACS/STEMI• Trauma• Stroke• Respiratory Distress• Cardiac ArrestEnhanced Bundle• Universal… the elusive 100% QI• Billing• Behavioral• Pain Management… (remember the patient satisfaction

metric?)

FirstPass

FirstPass Queue

Quality Measures

Call Review Status

Summary of Tests by Protocol

Beginning of Practice Variation

Health Information Exchange

• Anything missing?

Because of Aggregated Data..

CAD

ProQA ePCR

Hospital Data

Beginning of Outcome Reporting

Maintaining situational awareness on what is happening to our patients

Beginning of Outcome Reporting

What's in it for you

• It’s a tool that helps you do your job with fewer resources

• More time spent focused on where it needs to be – lets people do the work computers can’t

• You don’t have to sacrifice a quality program due to budget cuts

• Real-time feedback on how well your medics are meeting protocols

ROI?

• Allows the staff they have to see the calls that truly need their attention

• Efficient use of time and staff

• Use time to evaluate and improve instead of searching.

Don’t be “this guy”.. Working on what happened last month…

“Oh, and some reporter keeps calling for you…”

Thank You!

• Keep digging, • Work smarter, not harder,• Change is happening, with us or without us!

Questions?• For more information….

– www.FirstWatch.net– Tfitch@firstwatch.net– Bhorak@firstwatch.net