EMS Engagement Communication Tools and Strategies for Coordinating Patient Care
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1 EMS Engagement Communication Tools and Strategies for Coordinating Patient Care Presenters Orlando Rivera, MSN, RN, EMT-P ACS Program Coordinator Lehigh Valley Health Network Chris Greb, NRP Operations Manager Macungie Ambulance 1
2 Presenter Disclosure Information Orlando Rivera, MSN, RN, EMT-P Chris Greb, NRP EMS Engagement FINANCIAL DISCLOSURE: No Disclosures UNLABELED/UNAPPROVED USES DISCLOSURE: No Disclosures 3 Objectives I. Case Study II. CQI-Hospital I. PDCA II. Communication tools III. CQI-EMS IV. Summary 2
3 Case Study 39 year old male complaining of sharp, stabbing chest pain with sudden onset at 03:00 hours. The pain woke him from sleep. Patient states he has been ill with some type of stomach bug for the last three days Patient has no medical history Case Study Vitals: P = 98, BP = 116 / 70, RR = 22; Temp; 101.0; SpO2 = 96% EMS Actions: Oxygen, 12-lead, ASA, Nitro x 3 with no relief, Morphine 4 mg with significant relief. Request Pre-hospital MI Alert 3
4 Case Study - Outcomes EMS crew -Gets back to station and tells the oncoming morning crew about the crazy MI they had. Young guy, fever and a stomach bug, but really having an MI. 12-lead had elevation everywhere. High fives all around. Provider is crowned the MI king! ER doctor Cancelled the MI alert. Treated the patient for pericarditis. Thinks EMS needs some retraining. Cardiologist Really upset because he got out of bed at 4 am and didn t need to. This is why CQI is so important! What is CQI? Continuous Quality Improvement (CQI) is a quality management process that encourages all health care team members to continuously ask the questions, How are we doing? and Can we do it better? Edwards PJ, et al. Maximizing your investment in EHR: Utilizing EHRs to inform continuous quality improvement. JHIM 2008;22(1):32-7 4
5 The Institute for Healthcare Improvement (IHI) Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? PDCA Cycle Establish measures Select changes Test changes Implement changes Spread changes 5
6 PDCA requires daily practice What's the difference between a scientist and a third-grade science student? PDCA requires daily practice cont. They both know the definition of the scientific method... but a scientist actually practicesthe scientific method with a high degree of skill to solve endless diverse real-world problems 6
7 Communication Tools Score Cards Communication Tools Score Cards 7
8 Communication Tools EMS Score Cards Communication Tools EMS Score Cards 8
9 Communication Tools EMS Score Cards What happens after feedback is delivered to EMS? Option 1 Option 2 Quality Improvement! 9
10 Each case should be reviewed ASAP Most people can t recall what they had for lunch last week, much less a chest pain call they were on three months ago. Immediate feedback to the providers is key. Look for inconsistencies, confirm data accuracy Look for contributing factors Track contributing factors; look for trends Provide feedback to callers Looking for Trends Call # Dispatch Responding On-Scene At Patient 1st 12-lead 1st 12-lead indicating STEMI First ASA First Nitro Activation time Enroute Hospital D2BT Hospital At Hospital Hospital Time (minutes) :49 5:51 5:59 6:00 6:06 6:06 6:19 6:15 6:17 6:27 6: :54 21:56 22:06 22:07 22:18 22:18 22:10 22:17 22:26 22:21 22:34 22: :50 2:52 2:59 3:00 3:15 3:15 3:20 3:19 3:28 3: :00 8:02 8:10 8:11 8:18 8:18 8:18 8:29 8:27 8: :21 20:22 20:29 20:31 20:38 20:38 20:40 20:44 20:39 20:37 20:48 20: :02 12:03 12:11 12:12 12:15 12:15 12:15 12:35 12:20 12:45 12: :24 17:26 17:32 17:33 17:42 17:42 17:46 17:48 17:46 17:57 18: :28 8:30 8:36 8:36 8:41 8:41 8:46 8:50 8:46 8: :56 5:58 6:05 6:08 6:16 6:16 6:18 6:39 6:40 6:35 6:46 6: :25 16:25 16:28 16:25 16:31 16:49 16:37 16:56 16:38 16:49 16: :55 9:56 10:00 10:02 10:11 10:11 10:09 10:18 10:20 10:13 10:24 10: :12 5:14 5:23 5:24 5:48 5:48 5:48 5:44 5:48 5:55 56 Hospital D2BT (time) 1st medical contact to Balloon (hours:minutes) At Patient to ASA At Patient to Nitro At Patient to 12-lead 12-lead to activation At Patient to activation Total time with patient Pre-hosp MI alert requested Pre-hosp MI alert activated MI Alert Activated in hospital 7:13 1:13 0:19 0:06 0:09 0:15 0:27 x x x 0:01 1:54 0:03 0:10 0:11 0:08 0:19 0:27 x x 4:33 1:33 0:15 0:05 0:20 0:28 x x x 0:07 0:07 0:11 0:18 0:26 x x 21:36 1:05 0:09 0:13 0:07 0:01 0:08 0:17 x x x 12:51 0:03 0:03 0:20 0:23 0:33 x x x 18:27 0:54 0:13 0:09 0:06 0:15 0:24 x x x 0:05 0:09 0:14 0:22 x x 6:49 0:10 0:31 0:08 0:24 0:32 0:38 x x x 17:55 1:30 0:12 0:06 0:07 0:31 0:24 x x 10:27 0:07 0:16 0:09 0:09 0:18 0:22 x x x 6:51 1:27 0:24 0:00 0:24 0:24 x x x 10
11 Looking for trends Provider Comments Jones Greb Smith Doe Wilson Doe Smith Henry Rivera Doe Greb Jones Prehospital request was actually denied due to patient age (92). However LVH processed as Pre-hospital alert due to request from provider. Hospital calls it a consent delay Hospital states consent delay No PCI performed ER and Cardiology confirmed elevation and took patient to cath. lab where no blockage was found Hospital states no PCI ER and Cardiology confirmed elevation and took patient to cath. lab where no blockage was found Patient in rapid a-fib with no elevation during most of care. Upon arriving at hospital, last 12 lead showed elevation. Provider advised ER of this upon entering hospital Patient refused Cath Patient coded while walking to litter. V-fib, defib, 12 lead performed afterward Specific providers? Delays, Treatments, Errors Specific times of day Etc, Etc, Etc Score card Use to validate data collected after each case Use for benchmarking Use to put a spotlight on excellence! 11
12 Summary / Key Points Engage EMS in CQI initiatives early Involve service Medical Director Provide support as needed without pushing too hard Continue monitoring process and provide feedback often and consistently Presenter Disclosure Information Orlando Rivera, MSN, RN and Christopher Greb, NREMTP EMS Engagement: Communication Tools and Strategies for Coordinating Patient Care FINANCIAL DISCLOSURE: No Financial Disclosures 24 12
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