EMS Performance Improvement Toolkits

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EMS Performance Improvement Toolkits

• The EMS Performance Improvement Center
• www.EMSPIC.org

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The EMS Stroke Care Toolkit
The EMS Toolkit Project

• The Duke Endowment
• Phase I
• 300,000 annually 2004-2007
• Phase II

• Centers for Disease Control and Prevention (CDC)
• 250,000 for one year

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What is an EMS Toolkit?

• Detailed Report
• Evaluates an EMS specific topic
• Patient Care
• Service Delivery
• Personnel Performance
• Benchmarking with state and similar systems
• Recommendations for improvement
• Continuous use

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Six Sigma meets Public Health
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The Simplicity

• Web-Based
• NHTSA Version 2.2.1 Dataset
• Possibly Additional Data Elements
• No Prior Performance Improvement Knowledge
  Required
• TurboTax Implementation
• Visual Reporting Methodologies
• Massive Technical Assistance

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The Perception

• Its NOT
• Judgmental
• Negative
• Degrading
• Difficult

• It IS
• Easy
• Useful
• Helpful
• Educational
• Enabling
• Positive
• Worthwhile

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What is an Intervention

• Customized direction provided within each EMS
  Toolkit based on an individual EMS Systems
  results.
• Approximately 25 to 30 interventions or
  recommendations per EMS Toolkit
• Each EMS System is encouraged to choose 1 or 2
  for implementation within their System
• Rinse and Repeat

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The Toolkits

• Year 1
• Local EMS System Response
• State EMS System Design and Performance
• Year 2
• Cardiac Arrest Care
• Trauma Care
• Year 3
• Pediatric Care
• Acute Cardiac Care
• Stroke Care (CDC funded)

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A Match Made in Heaven

• Money from Duke Endowment
• EMS Toolkits from OEMS
• EMS Systems Use EMS Toolkits
• Duke Endowment money to EMS Systems to address
  EMS Toolkit identified issues.

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EMS Toolkit Phase II Project

• Funded by The Duke Endowment
• 1,600,000 to EMS Systems based on the EMS System
  Response Toolkit
• Continued funding to EMSPIC and OEMS
• Rinse and repeat (7 to 10 years)
• Request for Application to fund South Carolina

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EMS System Response TimeToolkit
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EMS System Response Toolkit

• Data Completion Rate
• EMS Response Times
• EMS Unit Availability
• EMS Transport Time
• EMS Total Call Time
• EMS Call Center Time
• Miscellaneous Factors

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Record Selection
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EMSResponseTimes
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Intervention 10Calls per Day of Week and Time of
Day

• The purpose of this intervention is to provide
  instruction on how to evaluate EMS event numbers
  by analyzing the number of calls by the day of
  the week and the time of the day. Information
  obtained from this analysis can be used to create
  improved EMS System Response plans which can
  improve EMS System Response Time.
• Each EMS Event typically requires an EMS unit to
  provide service delivery and care. If the number
  of EMS events outnumber the number of EMS
  vehicles which are staffed and in service at any
  point in time, the EMS Systems Response Time will
  increase.
• By receiving this intervention, the EMS System
  Response Toolkit determined that there were at
  least 5 times where the number of EMS events
  (averaged for the day of the week and hour of the
  day) equaled or exceeded the number of staffed
  EMS units in service during that same time.

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Recommended Plan of Action

• Implement a plan which will increase the number
  of EMS units during times when the number of EMS
  events are likely to be greater than the number
  of available EMS units. This could be done by one
  of the following methods
• Bring in additional peak time EMS units during
  hours where EMS events exceed normal staffing
  patterns.
• Change the EMS unit staffing pattern to place
  more EMS units in service during high volume
  times. For example, move an EMS unit which is
  normally in service during nighttime hours into
  service during daytime hours.
• Consider changing personnel staffing hours from
  24 to 12 hour shifts to allow more shifts (and
  EMS units) to be in service during peak hours.

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Community Demographics
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Fatal Injury Rates

• There is a 2112 (151) difference between the
  top 10 and bottom 10
• There is a 20 increase in the injury fatality
  rate
• The average EMS System Total Response Time for
  North Carolina is 2140 (mmss).

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EMS Response Toolkit Findings

• Data Completion and Accuracy Issues
• Long Wheels Rolling Times
• Unit Availability
• Long Transport Distances
• Call Center Times
• First Responder Coverage
• Vehicle Maintenance Plan
• Quality Management Program
• Demographic Trends

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North Carolina EMD
Alleghany
Northampton
Currituck
Warren
Ashe
Gates
Stokes
Surry
Camden
Caswell
Person
Rockingham
Vance
Hertford
Pasquotank
Granville
Halifax
Watauga
Wilkes
Perquimans
Yadkin
Chowan
Forsyth
Orange
Avery
Franklin
Bertie
Guilford
Durham
Mitchell
Alamance
Nash
Caldwell
Alexander
Davie
Edgecombe
Yancey
Madison
Tyrrell
Martin
Washington
Wake
Iredell
Davidson
Burke
Dare
Chatham
Randolph
Wilson
Mcdowell
Catawba
Rowan
Buncombe
Pitt
Beaufort
Haywood
Johnston
Greene
Hyde
Lincoln
Swain
Lee
Rutherford
Henderson
Harnett
Cabarrus
Cleveland
Wayne
Graham
Montgomery
Gaston
Jackson
Moore
Polk
Stanly
Lenoir
Mecklenburg
Transylvania
Craven
Macon
Cherokee
Pamlico
Clay
Cumberland
Hoke
Jones
Richmond
Union
Anson
Sampson
Duplin
Carteret
Scotland
Onslow
Robeson
Bladen
Pender

COUNTIES WITH EMD PROGRAMS
Columbus

COUNTIES WITHOUT EMD PROGRAMS
New Hanover
Brunswick
PENDING APPROVAL

68 Counties have approved EMD Centers 2
Counties are pending approval
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EMS Acute Trauma CareToolkit
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EMS Trauma Care Toolkit

• EMS System Characteristics
• Data Quality
• County Injury Statistics
• EMS System Capability
• EMS System Performance
• EMS Personnel Performance
• EMS Patient Outcomes
• EMS Injury Prevention

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Record Selection Criteria
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Injury Statistics
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Skills Performed
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Measurement Quiz 1

• You are given the following monthly report
• Intubation Success Rate
• What actions would you take?
• Are these equal?

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Injury Prevention
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EMS Cardiac ArrestToolkit
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EMS Cardiac Arrest Toolkit

• EMS Cardiac Arrest Overview
• Data Quality
• County CV Disease/Patient Statistics
• EMS System Capability
• EMS System Performance
• EMS Personnel Performance
• EMS Patient Outcomes
• EMS Education and Community Outreach

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Cardiac Arrest Etiology
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Arrest Location Type
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Utstein Template
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Community Outreach
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EMS Acute Cardiac Care(STEMI)Toolkit
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EMS Acute Cardiac Care Toolkit

• EMS Acute Cardiac Care Overview
• Data Quality
• County CV Disease/Patient Statistics
• EMS System Capability
• EMS System Performance
• EMS Personnel Performance
• EMS Patient Outcomes
• EMS Education and Community Outreach

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Overview
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Patient Selection
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County Statistics
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System Capabilities
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System Performance
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Personnel Performance
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Outcomes

• Number needed to Treat 15

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Community Education/Prevention
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EMS Acute Stroke CareToolkit
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EMS Acute Stroke Care Toolkit

• EMS Acute Cardiac Care Overview
• Data Quality
• County CV Disease/Patient Statistics
• EMS System Capability
• EMS System Performance
• EMS Personnel Performance
• EMS Patient Outcomes
• EMS Education and Community Outreach

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Patient Selection
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Patient Demographics
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System Capabilities
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Personnel Performance
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Outcomes

• Number needed to Treat 12

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EMS Acute Pediatric CareToolkit
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Pediatric Hot Issues

• Airway Management
• Circulatory Support
• Pain Management
• Special Needs
• Education and Prevention

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Patient Selection
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In Summary
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The Future

• 2007 EMS Grants based on EMS System Response
  Toolkit Results
• 1.6 Million
• 2008 EMS Grants based on EMS Trauma or Cardiac
  Arrest Toolkit Use
• 3 to 5 Million
• Regional Toolkits (North Carolina Regions)
• South Carolina
• National EMS Toolkit Access

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Questions ?