EMS Data Collection: Tips for Improving Data Quality
Just like any business or industry, EMS agencies benefit from regular assessments, QI/QA projects and accurate reporting that allows benchmarking and easily shared metrics. However, the ability to trust these metrics – for planning for budgets, understanding your community’s demographics, streamlining reimbursements, and more – depends directly on reliable and high-quality data.
EMS agencies typically collect a large amount of data on a wide range of variables. As more and more agencies began moving to electronic patience care records (ePCRs) in the late 1990s, the ability to standardize industry-wide verbiage and data sets laid the groundwork for more consistent records and easier analysis. Still, the fact remains that it takes a consistent, proactive commitment to improving and maintaining data quality to deliver useful, trustworthy observations.
Gaps in Older EMS Data Collection Systems
In the history of prehospital medical care and emergency response, medics were familiar with forming their documentation processes. In highly stressful situations where minutes could mean life and death, it was understandable that their focus was on helping their patient survive the ride to the hospital rather than precisely recording every impression or data point. Many relied on paper notes and scribbled information, making it a challenging handoff at a busy emergency department.
As nationwide organizations worked to standardize recommended data fields for EMS calls – starting with 81 fields from the National Highway Traffic Safety Administration (NHTSA) in 1993 – the effort to add consistency to industry-wide ePCR practices began. Today, in NEMSIS 3, there are 574 elements and the ability to describe EMS calls from both operational and clinical perspectives.
Understandably, EMS agencies pushing their medics to record more data (and have it complete by arrival at the ED) were met with some pushback. An already stressful job and a fast-paced environment were compounded by the need to fill out paper forms, renter the information into various databases, complete more paperwork back at the station, and fill in missing data on incomplete records.
Earlier electronic systems had their problems, with steep learning curves, clunky interfaces, and frustrating workarounds necessary to interact with other databases. Reporting and analytics often still required manual number-crunching or Excel spreadsheets. There was a definite need for better tools to enable accurate data collection without impeding patient care in an emergency setting.
NEMSIS & Federal Guidelines for EMS Data Collection
In 1996, the NHTSA Office of EMS developed the National Emergency Medical Services Information System (NEMSIS), a national repository for collecting, storing, and sharing standardized EMS data from states nationwide. Today, NEMSIS provides guidelines and a framework for collecting, storing, and sharing standardized EMS data and maintains this National EMS Database. It receives more than 30 million EMS submissions annually from more than 10,000 agencies across the U.S. Most EMS have committed to diligently meet the timelines and guidelines set by NEMSIS, helping develop an accurate picture of the EMS industry’s state.
State EMS Data Collection Standards Vary
Additionally, most states maintain their requirements and timelines for EMS agencies, often facilitated by their state Departments of Health. Local EMS agencies are expected to meet these requirements to remain compliant with their state guidelines. However, keeping up with these deadlines can be a job in itself. Thankfully, some of today’s top ePCR software tools for EMS offer built-in features to help automatically meet deadlines and submit required metrics.
The Value in Improved Data Collection for Emergency Medical Services
The benefits of accurate, high-quality data from EMS calls are wide-reaching and numerous. At the most basic level, this data offers EMS agencies straightforward operational insight for their agency. By comparing various variables, managers can check on agency performance and individual performance, identify areas needing improvement and check how their agencies compare with their peers. The metrics also help expedite reimbursements and are useful in forming more effective QI and QA projects that ultimately improve patient satisfaction and outcomes.
At a higher level, EMS data helps form a city-wide and state-wide understanding of communities and a national perspective on the state of the industry. In addition to regular operation metrics and information needed for budgetary discussions and planning, state-specific metrics can be reviewed as part of initiatives focusing on topics such as child abuse or elder care. EMS data can also help state legislators improve their constituents’ health and safety by understanding the most common health risks they face.
Preparing Data: Clinical Documentation in ePCRs
While ePCRs can differ by agency in what they contain, most should contain the basics such as primary impression, documentation of the event or incident, patient’s basic info (gender, age, etc.), patient’s medical condition and medical history, and treatment provided. However, the more specific a run report is, the more helpful it can be for health care providers at the ED and later analysis and learning opportunities. You may need to add additional information after the call, and it’s best to do so as soon after your handoff as possible.
Of course, the most basic information is extremely helpful for a smoother handoff at the ED, including fluids administered, medications administered, and primary/secondary impressions. These key data points affect the initial treatment and diagnosis by your health care partners working in the hospital and help them more quickly form a patient plan of action.
Other recommended best practices for a good run report for EMS providers include adding:
- Name, address, phone, social security, date of birth, medical insurance, next of kin, signatures, response time, location type, dispatch completing, added miles
- On-Scene Assessment: What is your general impression? Describe what you see when you arrived on the scene. What is the patient doing? What position is the patient in? Put the reader of your report in your scene. Be descriptive!
- Chief complaint, observations of the scene, findings of physical examination
- SAMPLE (Signs and Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events leading up to present injury) and OPQRST (Onset, Provocation, Quality of the pain, Region and Radiation, Severity, and Timeline)
- Treatment and transport decisions, including specific details about how a patient was transported to the ED and any changes in condition
By utilizing ePCR software tools, EMS agencies can customize the fields they wish their EMTs to complete for each call, making it easier to ensure the needed information is collected. This can be modified based on agency initiatives and areas of focus.
Additionally, many agencies work to ensure the majority of their run reports are complete for each shift and even use this standard for individual performance reviews. Some ePCR tools offer progressive forms that alert the user on any errors or missed fields while the form is being completed, ensuring more complete patient care records upon arrival at the ED.
Benefits of Improved EMS Data Quality
In addition to improving agency operational efficiencies and performance, improved data quality from EMS impressions can also directly impact the full healthcare spectrum, improving patient outcomes and making a more seamless transition to the hospital and long-term care if needed. It can also offer insight into the demographics of the communities served, highlighting areas of focus for community outreach or risk reduction programs.
Improved Patient Care
Improving the quality of your EMS data is not only helpful when it comes to reviewing metrics and creating reports but can have a direct impact on patient care. For example, quality improvement projects are vital in helping EMS agencies refine and improve protocols, offering concrete ways to measure how procedural changes affect outcomes.
Additionally, more complete ePCRs and run reports make it easier to learn from the trickier or more complex calls. Some conditions, like sepsis, do not have obvious symptoms or easy tests to diagnose in the field. The ability to review calls associated with less successful patient outcomes can provide an opportunity for individuals and the team as a whole to learn from mistakes, what was missed, and what could be done differently next time.
Improved Health in the Communities EMS Providers Serve
Information for EMS impressions is also helpful in allowing health care professionals to understand their communities better. Having a better knowledge of the most common injuries, health risks, and type of calls helps agencies and fire departments create more effective CRR programs. Hospitals similarly can use this information to fill out their trauma registries and work to prevent the most common type of injuries in their community.
EMS run data is also currently an important part of better understanding the most pressing health issues in the U.S., including the COVID-19 pandemic. By observing impression and symptom data, among other variables, health care professionals and researchers can better understand the progression of the virus, changing demographics, most common presenting symptoms, and more. Since March 2020, ESO has been maintaining a COVID-19 data dashboard based on EMS surveillance data. The online dashboard features a series of snapshot reports and graphs based on data obtained from the ESO database, consisting of more than 2,600 EMS agencies across the U.S., and updated daily.
Improved Communication With Hospitals
More complete and trustworthy data from EMS also helps hospitals provide better patient care. Knowing exactly what medical treatment has been administered before arrival to the emergency department helps hospital professionals quickly plan their first steps in care and enable physicians to form a better overall picture of the patient’s condition and arrive at diagnosis more quickly.
EMS Software and ePCRs Designed to Improve Data Collection
While the demand and expectations for ePCRs rise with their potential benefit to public health and quality improvement, many EMS agencies are turning to EMS software to help make the work more efficient and reliable. Tools like ESO Electronic Health Record (EHR) makes it easy to produce quality EMS clinical documentation and includes built-in analytics to help turn data into actionable information. Features like patient lookup, specialty patient forms, and integration with other databases and systems make the in-field work faster and more efficient than ever.
For more information on ESO EHR, the next-generation of ePCRs, take a product tour now.
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