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