data – its only a four-letter word if you don’t use it. bernie horak, b.s. emt-p clinical...
TRANSCRIPT
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Data – Its only a four-letter word if you
don’t use it.
Bernie Horak, B.S. EMT-PClinical SpecialistFirstWatch L.L.C.
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What is “Data”
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What is “Data”
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Factual Information (as measurements or statistics) used as a basis for reasoning,
discussion or calculation
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EMS DataBP
SPO2
PulseEKG
Address
Time to Dispatch
PMHX
Meds
EKG
Medic
Response Time
Medicare #
Phone #Dispatch Dx
Protocol
Hospital
Drop Time
Pain scale
911 Ring
ANI/ALI
Scene Time
UHU
Stoke Scale
Allergies
Bystander CPR
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EMS DataBP
SPO2
PulseEKG
Address
Time to Dispatch
PMHX
Meds
EKG
Medic
Response Time
Medicare #
Phone #Dispatch Dx
Protocol
Hospital
Drop Time
Pain scale
911 Ring
ANI/ALI
Scene Time
UHU
Stoke Scale
Allergies
Bystander CPRData, Data, Everywhere,
But Not a Drop of Information
You Can Have Data Without Information – But You Can’t Have Information Without Data
- Daniel Keys Moran
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Data- Information: Why do we care?
• Old public model
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Data- Information: Why do we care?
• Old private model
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We were the “good guys”
• “You did the best you could for poor Mrs. Smith.”
• We were nice…
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Today’s response
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Where are we headed?
• “You did your best…. By the way, what percentage of your cardiac arrest patients have return of spontaneous circulation?”
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Where are we headed?
• “You did your best…. By the way, what percentage of your cardiac arrest patients have return of spontaneous circulation?”
• “How does that compare with other EMS systems your size?”
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Who’s asking?
• City/County governments
• News media• Insurance companies• The largest insurer of all….
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Evolution and Emergence
Healthcare is evolvingEMS is evolving
More sophisticatedMore data
Data used for metrics
Payment for healthcare is evolvingMetrics measure quality
Quality determines payment
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Future of EMS Payment
• Patient calls 911• Is this a treatable condition?
• Was the right care given • How was the patient experience
• Did patient get better• Pay for quality
Value based purchasing model
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Is this very far off?EMS
?
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But What’s Possible Without……
And then there were none!!
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Traditional Quality Improvement
Labor intensive, time consuming and quite often confusing
Retrospective
Leaves little time to truly monitor and improve care
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Lots of Data
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Where are your problems?
The One that didn’t follow protocol
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Change
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The Desired Road Map
• Commitment• Empowerment• QI Infrastructure• Customer Service• Teamwork & Collaboration• Continuous Process
Improvement
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Discovery
What are you currently doing today to measure quality improvement?
How do the pieces fit together?
Where do you want to be?
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Identify your target
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Creating a Culture of Quality
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Goals of CQI
• Protocol compliance• Patient outcome• Documentation quality• Paramedic feedback
• “Continuous”
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Problems/Challenges of CQI
•Size Number of paramedics/calls/protocols
•Personnel constraints How many calls can be reviewed by hand?
•Myopic Only looking at protocols and outcomes that you are interested in e.g. cardiac arrest•Quality measures tied to reimbursement?
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Which Road Will You Take?
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Software does the Heavy Lifting
• Information is pre-sifted and evaluated for key indicators versus pulling information in a reactive way.
• Data is made available in near real time for analysis and communication with clinicians in timely manner
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Human factors
• Lets people find the problem and in time to correct it!
• Don’t search..fix
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What needs addressing?
• An individual…
• Or is it a system issue?
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What do we measure today?
• California Core Measures….
ACS– >35 y/o ASA?
Yes/No– 12 lead ?
Yes/No– Scene time for 12-lead + for STEMI <14:20– Hospital notified for + STEMI Yes/No– Transport to a PCI center for +STEMI Yes/No
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What does it tell you?
• Data points not information• It’s a starting point not a destination
– Does tell you if information is being collected– Gives you an idea if its accurate– Low hanging fruit
– At least it’s a start… and gives you a benchmark..
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Documentation Quality
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•“If it wasn’t documented, it wasn’t done”
•Software cannot detect the values of the data that is missing – but it can tell you what data is missing ?
•Encourages improvements of documentation to get “credit” for what was done.
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What is it missing?
• Our patient care is not yes/no
• Is it a system issue or an individual problem
• Can all of the answers to the elements be NO and still have good care?
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One Customers Methods
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Patient Outcomes are not Yes and No questions
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•Patient outcomes also need to be measured in similar fashion • If the patient had pain, was it managed appropriately?
• Were there two pain scales done?• Were either above x/10?• If either were, was pain medication administered?• Did the patients pain decrease?• If no pain meds, was there a reason?
• Allergies• Patient reluctance• Unstable vital signs
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Start Small
Standard Triggers • Response times• Turnout times• Call processing times
Clinical Triggers• Patient assessment data• Procedures performed• Timed criteria
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Move Fast
• Sentinel Alerting– Clinical
• Missed airways / Missed EtCO2 documentation• Medical Director’s “hot buttons” – peds intubations?• MERS…
– Operational• Response times over…20 minutes?• Vehicle failures• Political “hot buttons”
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Add onProtocols - Bundle of care – benchmarking • ACS/STEMI• Trauma• Stroke• Respiratory Distress• Cardiac ArrestEnhanced Bundle• Universal… the elusive 100% QI• Billing• Behavioral• Pain Management… (remember the patient satisfaction
metric?)
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FirstPass
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FirstPass Queue
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Quality Measures
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Call Review Status
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Summary of Tests by Protocol
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Beginning of Practice Variation
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Health Information Exchange
• Anything missing?
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Because of Aggregated Data..
CAD
ProQA ePCR
Hospital Data
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Beginning of Outcome Reporting
Maintaining situational awareness on what is happening to our patients
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Beginning of Outcome Reporting
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What's in it for you
• It’s a tool that helps you do your job with fewer resources
• More time spent focused on where it needs to be – lets people do the work computers can’t
• You don’t have to sacrifice a quality program due to budget cuts
• Real-time feedback on how well your medics are meeting protocols
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ROI?
• Allows the staff they have to see the calls that truly need their attention
• Efficient use of time and staff
• Use time to evaluate and improve instead of searching.
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Don’t be “this guy”.. Working on what happened last month…
“Oh, and some reporter keeps calling for you…”
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Thank You!
• Keep digging, • Work smarter, not harder,• Change is happening, with us or without us!
Questions?• For more information….
– www.FirstWatch.net– [email protected]– [email protected]