National Assessment of Clinical Quality Programs Introduction With the support of the NAEMSP Quality Improvement Committee, this study group is interested in understanding the national picture of clinical quality improvement activities. Please complete the following research survey on Quality Improvement in your EMS agency. This will help to define the current state of clinical quality programs which we hope to share with the EMS community. Before starting, please review the attached PDF survey material so that you can briefly prepare to answer agency specific data in the online survey without difficulty. It will take about 10 minutes to complete. Your participation is completely voluntary and is greatly appreciated. While we would like to understand practice patterns in different regions, we understand that you may wish to keep your responses anonymous. If you decide to share your personal information, your information will be secured and shared only with your permission. Please limit responses to ONE per LOCAL AGENCY. If you are affiliated with a national, state or regional company with multiple local agencies, please promote this to your local affiliates. For questions or concerns, please contact Michael Redlener, MD at mredlener@chpnet.org National Assessment of Clinical Quality Programs Demographics * 1. What is your role at your EMS Agency? Medical director Quality Improvement/Assurance coordinator or director Designated employee with involvement in QI/QA Designated employee with minimal involvement in QI/QA * 2. What state do you practice in? State: -- select state -- 1
3. What region/county do you practice in? * 4. What is the population of this region? Total day-time population: Total night-time population: 5. If you serve a subsection of the region, please estimate population served in your area. * 6. What agency type do you work in? Municipal Fire Service Municipal Third Service Hospital-based Police Agency Private Air Medical/Critical Care * 7. Describe the employment structure of your EMS agency Paid Volunteer Combination * 8. How would you describe your working environment? (mark all that apply) Urban Rural Suburban Wilderness 2
* 9. Describe your agency provider composition? (mark all that apply) EMR or Certified First Responders EMT-B Providers EMT-I/AEMT Providers EMT-P Providers Critical Care Nurses Physicians National Assessment of Clinical Quality Programs Demographics (Continued) * 10. In 2014, how many independent units/ambulance are deployed per day on average as part of your EMS agency? * 11. How many Paramedics does your agency employ? * 12. How many EMT-Bs does your agency employ? * 13. How many EMT-Is/AEMTs does your agency employ? * 14. In 2014, how many calls did your ambulance agency respond to in 2014? * 15. Of these, how many were 9-1-1/emergency calls? * 16. Of these, how many were interfacility or non-emergency calls? (Ie Question 14 minus Question 15) 3
* 17. How many of your 9-1-1/Emergency calls in 2014 got transported to the hospital? * 18. How many of your transports in 2014 were ALS? * 19. How many of your transports in 2014 were BLS? National Assessment of Clinical Quality Programs Agency Activity Data * 20. On average, how much time does your agency Medical Director(s) provide to your agency? 40 hours/week 20-40 hours/week 10-20 hours/week 5-10 hours/week 3-4 hours/week 5-10 hours/month <5 hours/month None 21. Does your medical director receive payment? Yes - Salaried Yes - Hourly Yes - Stipend No - Volunteer 4
* 22. Do you have a Quality Improvement staff employed by your agency? (Ie people to address clinical and operational/billing aspects) Yes No * 23. How many Full Time Equivalents (FTE) are dedicated to this QI effort? (either clinical or nonclinical/billing) * 24. On average, how many hours/week does your staff spend on QI in total? * 25. How many FTE are dedicated to clinical Quality Improvement (i.e. not billing and coding or operations)? * 26. What activities do you consider to be part of your clinical QI (check all that apply)? Chart review Provider review Evaluation of established clinical quality metrics Education * 27. What calls does your QI staff review (check all that apply)? All Any call in which an incident was reported Any call in which an invasive procedure is done (intubation, needle thoracostomy, etc) all critical call types Random sub-selection of calls New members/promotions 5
* 28. Do you follow clinical metrics to assess ongoing clinical quality? Yes No * 29. How did you develop/identify these metrics (Check all that apply)? Literature review State or region mandated To meet specific programmatic needs In conjunction with an accrediting or quality organization (i.e. National Quality forum) Organizational/Corporate direction Other * 30. Do you use a software vendor or clinical quality data management program? No Yes If yes, please list vendor * 31. Do you participate in an outside research agency and/or clinical quality network? No Yes - CARES Yes - ROC Yes - AHA Mission Lifeline Yes- Corporate EMS agency (multi-regional, state or national) Yes - Other If other (please specify) 6
32. Please select one of the following for each question Not at all Sporadically Annually Monthly Weekly Daily How often does QI feed back into CME/Education? How often does your QI enable feedback to providers? How often does your agency have direct access (i.e. direct access into hospital medical record system) to see patient outcomes? How often does your agency have indirect access (i.e. a contact at the hospital who can look up and provide follow up upon request) to medical records/outcomes of patients after they reach the hospital? How often do individual providers have direct access to the medical records/outcomes of patients after they reach the hospital (i.e. they can look up information in hospital medical records)? How often can individual providers have indirect access to the medical records/outcomes (i.e. get follow up on specific patients by asking staff)? National Assessment of Clinical Quality Programs Quality Indicators For this section, please indicate if your agency tracks the following indicators. We have identified many areas in this survey and it is not expected that all groups will track all areas. Please click any areas that apply. 7
* 33. Cardiac Arrest AED use prior to EMS arrival Average time to AED analysis Chest compression rate Chest compression fraction Perishock pause People defibrillated with ventricular tachycardia or ventricular fibrillation Out-of-hospital cardiac arrests return of spontaneous circulation Out-of-hospital cardiac arrests survival to hospital discharge Neurologically intact survival to hospital discharge * 34. ACS/Chest pain Aspirin administration for chest pain/discomfort 12 lead EKG performance Scene time for suspected STEMI patients First medical contact (FMC) to ECG times FMC to hospital arrival time FMC to balloon time Direct transport to PCI center for suspected STEMI patients meeting your local criteria 8
* 35. Trauma Scene time <10 minutes for severely injured non-entrapped trauma patients Direct transport to trauma center for severely injured trauma patients meeting your local criteria * 36. Stroke Identification of stroke in the field/use of Prehospital Stroke Screen Documentation of 'last known normal' time Documentation of glucose testing for suspected stroke Scene time for suspected stroke patients Advance hospital notification for suspected stroke patients meeting your local criteria Direct transport to stroke center for suspected stroke patients meeting your local criteria * 37. Seizure Documentation of glucose testing Benzodiazepine given in compliance with protocol Seizure controlled 9
* 38. Respiratory distress CPAP given for patient with respiratory distress/suspected CHF Beta-2 agonist administration Oxygen given in compliance with protocol Oxygen saturation measured prior to intervention * 39. Pediatrics Pediatric asthma patients receiving bronchodilators Transport to pediatric trauma center for patients meeting your local criteria * 40. Pain treatment Pain intervention given in compliance with protocol Results of pain intervention leading to pain improvement (i.e. monitor improvement in pain scale) * 41. Skill performance Endotracheal intubation success rate End-tidal CO2 performed on any endotracheal intubation Undetected esophageal intubation rate Medication error rate 10
* 42. EMS response and transport Ambulance response time in minutes by ambulance zone (emergency) Ambulance response time in minutes by ambulance zone (non-emergency) On-scene time (emergent) Transport time (emergent) Transport of patient to hospital Emergency department turnaround time Delay-causing crash rate per 100,000 fleet miles EMS crash injury rate per 100,000 fleet miles EMS crash death rate per 100,000 fleet miles * 43. Public Education/Interaction Out-of-hospital cardiac arrest receiving bystander (non-ems personnel) CPR Patient satisfaction rate Call complaints (per 1,000 calls) National Assessment of Clinical Quality Programs Challenges to Quality Improvement 11
* 44. Please report the level of ease for each of the following in terms of monitoring a clinical quality metric Time availability Not at all a problem Relatively easy Neutral Relatively difficult Huge problem Resource availability Electronic medical record Data quality Availability of hospital follow up Buy-in of providers * 45. What resources would be useful to you to improve your ability to conduct clinical quality improvement in your agency? Time availability Resource availability Electronic medical record Data quality Availability of hospital follow up Buy-in of providers 46. Would you be willing to answer additional questions regarding EMS Quality Improvement or participate in a focus group? No Yes (please provide email and phone number) 12