Keep it Simple: Integrating EMS and Hospital Communications
The best presentations at ESO’s annual Wave conferences turn into conversations among attendees and presenters. Everyone shares experiences, “aha” moments, and resources. That’s what happened when Karrie Austin, RN, hosted a session titled, “EMS and Hospital Integration: Why EMS is a Good Partner.”
Austin is Trauma Program Manager and EMS Coordinator at Good Samaritan Hospital, part of the Multicare Health System in Puyallup, WA. She shared her journey convincing not just one hospital but also her whole system – and even some competing facilities – to share data with EMS via ESO tools. She took up this gauntlet after her facility had twice said “no” to EMS and ESO personnel.
The secret to success?
“Keep it simple,” Austin said.
“Simple,” in Austin’s telling, means to avoid making big presentations to rooms full of busy people who already have too much to worry about. Many people are predisposed to say “no” in those situations, and one “no” is enough to kill the project in that setting.
An Individualized Approach
Instead, Austin held small, one-on-one sessions with influencers where she could point out shared hospital experiences – such as the observation that paper records left in the emergency department can “grow legs” and never make it into a patient’s chart. To others, she shared the benefits of better records on reimbursements and compliance with core measures. Elsewhere, she showed that EMS is administering more treatment in the field than caregivers understood and that more cooperation with EMS in the field could improve patient outcomes.
Austin kept the benefits specifically of ESO bidirectional communication software – ESO Health Data Exchange (HDE) – in mind as she outlined the pain points and the answers provided by better communication along the full continuum of care, prehospital to ED and beyond.
‘Simple’ Health Data Exchanges Can Improve Patient Care
As most medical professionals in emergency healthcare would agree, patient care begins long before they reach the ED doors. In many cases, minutes can make a difference when it comes to receiving the proper treatment and improving outcomes. From field impressions to initial care rendered, the field observations can help providers within the hospital make quicker, more efficient decisions once the patient arrives.
The ability to send alerts to the hospital while in route or assemble a team ready to receive a particularly critical patient can make a life-and-death difference for the patient and significantly improve care coordination. Sending photos and detailed notes while en route can give hospital staff a more complete idea of what’s about to arrive, and seamlessly handing off a more comprehensive electronic health record that integrates into the hospital’s system saves time and reduces human error.
Similarly, the ability for EMS agencies to receive follow up notes and final diagnosis plans – “closing the loop” on the patient – provides an invaluable teaching opportunity to see what was correctly diagnosed, what was perhaps missed, and what can be learned for patients presenting similar symptoms in the future. This health information exchange between EMS and hospital not only improves efficiencies but promotes patient health and safety, for the current patient and those to be treated in days and months to come.
Information-Sharing Gaps Across Older Healthcare Systems
Poor handoff communication between EMS and ED can be a contributing factor to both adverse and sentinel events. If you have had any of those in the last year, that is a good starting point to review what can be improved during patient handoff.
Sharing patient data via a digital record of the pertinent information– an electronic patient care record (ePCR) – in real-time increases overall efficiency for both prehospital and hospital providers. Medics no longer have to repeat handoff information multiple times to different providers caring for the same patient.
Similarly, hospital staff won’t have to “play detective” to find critical information since it is already in the ED system. Paperwork won’t get left behind, shuffled, or lost. And patient records often arrive at the ED more complete and correct, thanks to software tools featuring “progressive validation,” meaning the ePCR cannot be marked complete without predefined fields being fulfilled.
While healthcare providers along the continuum of care work diligently to provide the best care for their patients, it can be the smallest details – like how efficiently the patient is handed-off at the ED – that can help deliver quality care and promotes public health.
What’s Stopping Healthcare Organizations from Integrating & Partnering with EMS?
Unfortunately, there are historically some roadblocks between the working relationship of EMS and hospitals. An “us versus them” mentality can cause a divide, leaving EMS feeling under-appreciated and hospital staff feeling overstressed. EMS transport values start to dip, and practices between the two organizations lack cohesiveness.
However, an improved working relationship with EMS can benefit hospitals in ways that extend beyond just the immediate patient outcome. Statistics show that an average of 20-30% of patients in the emergency department arrives via an ambulance. EMS agencies often have the opportunity to choose which hospitals they’ll transport to, and an easier handoff can play into this decision. This can directly impact hospital revenue, especially if agencies are transporting higher acuity patients.
Additionally, many measures that impact a hospital’s rating can be affected by the EMS/ED handoff. Hospitals are often graded on door-to-needle time, door-to-cath time, and minutes spent on assessments and screens. Utilizing the patient information in the paramedics’ ePCR can save nurses and physicians valuable time, freeing them up to ask only clarifying questions as needed. Honoring cath lab alerts and meeting the ambulance at the door shows that the ED staff trusts and takes EMS alerts seriously.
Data sharing via tools like ESO HDE improves patient care and helps change the culture of the EMS/ED relationship. Closing the loop of patient outcomes with EMS offers agencies a chance to improve and learn and build better working relationships throughout the continuum of care. The final result is not only more efficient operations but healthier communities.
How One Nurse Brought Change Within Her Healthcare Organization
Back in Washington, Karrie Austin continued to work away at proving the value of sharing patient data electronically to various stakeholders in her hospital.
“Trying to get everyone on the same page was a major challenge,” Austin said.
Her struggle clearly resonated with the assembled professionals in the audience. One attendee shared that a hospital their agency worked with discovered that patients EMS delivered were often recorded as “walk-in” for simple reasons of expediency or inability to remember after the fact. Another offered that integration can be an ongoing process; tweaks and updates in other hospital systems can have a cascading effect, removing a data point from ESO’s dashboards. So, the partnership – once forged – has to be maintained.
Benefits of Sharing EHR & Vital Healthcare Data
Austin has helped the patients in Washington. But, she is not standing still. Once you achieve integration, you can use analytics to fine-tune your EMS-hospital partnership, and that is Austin’s next endeavor. She hopes to reduce times on performing EKGs in the field based on certain indicators, tighten any variances between pre-and post-treatment diagnoses and bring rehab and long-term care facilities in her region on board with ESO.
She encouraged the audience to get started on integration by finding “a champion in your particular hospital.” Those champions can lead to more like-minded administrators as long you “Keep it Simple.”
Learn more about how communication can improve care in the white paper, Improve Patient Care with Hospital EMS Data Exchange.