Happy Friday.
Attached are the state CQI performance measures for January 2021-December 2022. Washington County is represented by the letter “M”.
To help you understand some of the slides (as well as why we have documentation standards), it sometimes helps to see the areas in which we could use some improvement – as well as highlight some of our strengths.
TRA-1: Scene time for trauma patients. This is strictly the amount of time (based on CAD data entered into emeds) spent ON SCENE with patients labeled as trauma patients in emeds reports. As you can see, our average is hovering around the 25-26 minute mark. Some of this is going to be impacted by our geographical extended wait for trooper times. As a system, looks like we are pretty average with the state, but we do have some room for improvement. Remember that our total on scene time goal with a trauma patient is 10 minutes. A Side note here: current helicopter utilization review for Washington County, despite length of initial Trooper ETA, has verified that calling for aviation EARLY is still time-saving and beneficial for the patients in our area, especially when destinations are specialty centers in the metro area.
TRA-2: Direct transport to trauma center for trauma patients. This document evaluates all emeds reports that are labeled as trauma patients – making sure the destination listed is a trauma center. As you can see, we do really well considering our primary local destination is also a trauma center.
TRA-3: Pain Assessment for Injured patients. We’ve gotten a little better documenting pain scores, but have major room for improvement. I imagine this data will improve with continued QI push to encourage pain score documentation in the vitals section. Remember, this report does not pull data from the narrative… only the appropriate data boxes. Make sure to utilize the pain score documentation tool in the vitals section.
TRA-4: Multiple pain assessments for injured patients. When we DO document pain scores appropriately, we are documenting more than one. Still less than 70%, but we can definitely do better with pain score documentation overall.
TRA-5: Measurement of patients with a decrease in their pain scale. Well, this one is obvious. It requires at least two pain scores. I would have to dig a little deeper into these values. I don’t know that we aren’t attempting to mitigate or treat a patient’s pain. Just know this is a value that the state is evaluating. Our ability to effectively mitigate pain.
ACS-1: Aspirin administration for chest pain/discomfort. Based on this population in emeds as documented by your primary field impression – I am hoping next year’s numbers appear a little better, as we are now encouraging the documentation of self-administered, or administered prior to arrival, aspirin in the medications drop down section.
ACS-2: 12 Lead ECG performance. This is JUST making sure a 12 lead is completed on patients that are documented with ACS/chest pain/discomfort. As you can see, we are close….but not quite…at 100%. With BLS acquisition, we don’t have much reason to not be at 100% on this measure.
ACS-3: Scene time for STEMI patients. Measures patients that are documented as STEMI identified patients. Again, we are hovering right around the 23 minute mark. Keep in mind these times may be impacted going forward with the implementation of the critically unstable patient protocol that may require stay-in-place efforts. If your patient does not meet the CUP protocol, try to make a conscious effort to spend less time on scene with STEMI patients.
ACS-4: Advance Hospital Notification for STEMI patients. I know you are doing this one. This will have a major jump in compliance since we made the field in emeds mandatory.
ACS-5: Direct transport to designated STEMI receiving center for suspected patients meeting criteria: Like traumas, our primary local destination is also a STEMI receiving center, so we do really well in this category.
ACS-6: Time to EKG. Our numbers are steadily decreasing, and look decent – comparatively speaking. We have spent years encouraging and giving feedback to decrease our door to ecg times. Great job, everyone. We can get those numbers even lower. Let’s shoot for a standard of less than 5 minutes when indicated.
STR-1: Prehospital Screening for Suspected Stroke Patients I think the entire state has nailed this measure. Keep it up.
STR-2: Glucose testing for suspected stroke patients. Close to 100%.
STR-3: Scene time for suspected acute stroke patients. 22-23 minute mark. Goal would be 10 minute scene time unless CUP criteria/intervention is needed.
STR-4: Advance Hospital notification for stroke patients. We were doing poorly at documenting this. With some changes to the mandatory fields in emeds, I think we will see an sharp jump in compliance.
STR-5: Percent of patients with positive Cincinnati that also have documented LAMS score. This isn’t a measure we have pushed in the past, but will be cognizant of moving forward. Start to get in the habit of documenting both scores for stroke patients if you haven’t already.
HYP-1: Treatment administered from hypoglycemia. This is highly dependent on the documentation of medications in the medications section of the PCR in emeds. (Which is one reason I stress timestamping medications in the appropriate section in lieu of the narrative. Data cannot be pulled from the narrative.)
MD OPIOID – 1: Naloxone given and no transport made out of all patients naloxone given. In 2021-2022, roughly 30% of patients who were given Narcan were not transported by EMS in Washington County.
Attached are the state CQI performance measures for January 2021-December 2022. Washington County is represented by the letter “M”.
To help you understand some of the slides (as well as why we have documentation standards), it sometimes helps to see the areas in which we could use some improvement – as well as highlight some of our strengths.
TRA-1: Scene time for trauma patients. This is strictly the amount of time (based on CAD data entered into emeds) spent ON SCENE with patients labeled as trauma patients in emeds reports. As you can see, our average is hovering around the 25-26 minute mark. Some of this is going to be impacted by our geographical extended wait for trooper times. As a system, looks like we are pretty average with the state, but we do have some room for improvement. Remember that our total on scene time goal with a trauma patient is 10 minutes. A Side note here: current helicopter utilization review for Washington County, despite length of initial Trooper ETA, has verified that calling for aviation EARLY is still time-saving and beneficial for the patients in our area, especially when destinations are specialty centers in the metro area.
TRA-2: Direct transport to trauma center for trauma patients. This document evaluates all emeds reports that are labeled as trauma patients – making sure the destination listed is a trauma center. As you can see, we do really well considering our primary local destination is also a trauma center.
TRA-3: Pain Assessment for Injured patients. We’ve gotten a little better documenting pain scores, but have major room for improvement. I imagine this data will improve with continued QI push to encourage pain score documentation in the vitals section. Remember, this report does not pull data from the narrative… only the appropriate data boxes. Make sure to utilize the pain score documentation tool in the vitals section.
TRA-4: Multiple pain assessments for injured patients. When we DO document pain scores appropriately, we are documenting more than one. Still less than 70%, but we can definitely do better with pain score documentation overall.
TRA-5: Measurement of patients with a decrease in their pain scale. Well, this one is obvious. It requires at least two pain scores. I would have to dig a little deeper into these values. I don’t know that we aren’t attempting to mitigate or treat a patient’s pain. Just know this is a value that the state is evaluating. Our ability to effectively mitigate pain.
ACS-1: Aspirin administration for chest pain/discomfort. Based on this population in emeds as documented by your primary field impression – I am hoping next year’s numbers appear a little better, as we are now encouraging the documentation of self-administered, or administered prior to arrival, aspirin in the medications drop down section.
ACS-2: 12 Lead ECG performance. This is JUST making sure a 12 lead is completed on patients that are documented with ACS/chest pain/discomfort. As you can see, we are close….but not quite…at 100%. With BLS acquisition, we don’t have much reason to not be at 100% on this measure.
ACS-3: Scene time for STEMI patients. Measures patients that are documented as STEMI identified patients. Again, we are hovering right around the 23 minute mark. Keep in mind these times may be impacted going forward with the implementation of the critically unstable patient protocol that may require stay-in-place efforts. If your patient does not meet the CUP protocol, try to make a conscious effort to spend less time on scene with STEMI patients.
ACS-4: Advance Hospital Notification for STEMI patients. I know you are doing this one. This will have a major jump in compliance since we made the field in emeds mandatory.
ACS-5: Direct transport to designated STEMI receiving center for suspected patients meeting criteria: Like traumas, our primary local destination is also a STEMI receiving center, so we do really well in this category.
ACS-6: Time to EKG. Our numbers are steadily decreasing, and look decent – comparatively speaking. We have spent years encouraging and giving feedback to decrease our door to ecg times. Great job, everyone. We can get those numbers even lower. Let’s shoot for a standard of less than 5 minutes when indicated.
STR-1: Prehospital Screening for Suspected Stroke Patients I think the entire state has nailed this measure. Keep it up.
STR-2: Glucose testing for suspected stroke patients. Close to 100%.
STR-3: Scene time for suspected acute stroke patients. 22-23 minute mark. Goal would be 10 minute scene time unless CUP criteria/intervention is needed.
STR-4: Advance Hospital notification for stroke patients. We were doing poorly at documenting this. With some changes to the mandatory fields in emeds, I think we will see an sharp jump in compliance.
STR-5: Percent of patients with positive Cincinnati that also have documented LAMS score. This isn’t a measure we have pushed in the past, but will be cognizant of moving forward. Start to get in the habit of documenting both scores for stroke patients if you haven’t already.
HYP-1: Treatment administered from hypoglycemia. This is highly dependent on the documentation of medications in the medications section of the PCR in emeds. (Which is one reason I stress timestamping medications in the appropriate section in lieu of the narrative. Data cannot be pulled from the narrative.)
MD OPIOID – 1: Naloxone given and no transport made out of all patients naloxone given. In 2021-2022, roughly 30% of patients who were given Narcan were not transported by EMS in Washington County.
Melanie Higgins, BS, NRP Captain – EMS Quality Assurance Division of Emergency Services 16232 Elliott Parkway Williamsport, MD 21795 (cell) 301-491-2454 (office) 240-313-4376 (fax) 240-313-4375
Performance-Measures-Feb-2023.pdf