Improve EMS Metrics: 3 Crucial Steps

Performance metrics are becoming increasingly important in the health care industry, and EMS agencies are beginning to feel the effect. “Value-based health care” is on the rise and the percentage of healthcare payments tied to value-based care reached 34% in 2017, up 23% from 2015. As such, more payers are taking closer looks at what services are adding value, providing high quality care, and improving clinical outcomes.

Beyond simple metrics such as response time, how can an Emergency Medical Services agency ensure it is prepared to prove its quality or care and also identify areas for improvement to make it more competitive and preferred? In a recent JEMS article, several potential ideas for improving and maintaining EMS metrics gauging “quality” were outlined, including:

1. Bundle Up Clinical Operations

More research is surfacing on the connection between specific EMS protocols – or “clinical bundles” – and improved patient outcomes. For example, evidence-based procedures tied to improved outcomes for cardiac arrest patients include:

• early CPR,
• early defibrillation,
• effective airway management,
• and chest compression fraction.

Similarly, clinical bundles for STEMI include:

• aspirin (if not allergic),
• 12-lead EKG,
• pre-arrival activation of interventional cardiology team as needed,
• direct transport to PCI-capable facility,
• and EKG to PCI transport in under 90 minutes.

Some of today’s top EMS-specific software can be used to incorporate criteria measures and protocol steps into a patient’s electronic patient care record (ePCR). For example, virtual forms can be used in the team’s computer system to provide a step-by-step, or “progressive,” reporting process that directs the team to the net appropriate clinical task. These customized tools can also require specific tasks are completed or at least intentionally bypassed before moving on to the next step. All of these factors also increase the likelihood of a patient arriving at the receiving hospital with a completed ePCR, making the hand off to the ED staff more efficient and effective.

As more groups of proven actions are tied to specific types of calls, EMS agencies can integrate these steps into their protocol and criteria. Some agencies have gone as far as “report cards” for each call. These track the completion of these steps to encourage teams to be sure to conduct as many as possible, as often as possible, for each appropriate case. By setting a goal for the teams – for example, all clinical bundle actions completed for at least 90% of calls – EMS agencies can put metrics around concrete steps for improvement of care.

2. Look at Additional Related Operational Metrics

There are other non-traditional performance metrics that can help reflect the “quality” of service being provided by an EMS agency. For example, officers can regularly review EMS data such as:

• Mission failures per 10,000 miles
• Ambulance crashes per 10,000 miles
• Patient complaints per 1,000 contacts
• Employee injury per 10,000 hours worked

While many of these metrics are not directly tied to the team’s interaction with the patient, this type of data collection within EMS systems can help shed light on potential problems or areas for improvement.

3. Integrate National Benchmarks

It can be helpful to see how your agency is measuring up to the performance of other EMS teams across the nation, as a way to both set your own goals and to identify your agency’s strengths and areas of growth. A useful tool in this regard is an industry-wide benchmark like the 2018 ESO EMS Index: Insights and Best Practices for EMS Agencies, initially released in February 2018 and then updated mid-year in September 2018.

The ESO EMS Index complies data from more than 1,000 agencies and 5.02 million patient encounters from Jan. 1–Dec. 31, 2017.

• Stroke assessment performance
• EtCO2 assessment after advanced airway procedure
• 12-lead EKG performance in adult chest pain
• Percent of patients who are suffering from overdose
• Aspirin administration in adult chest pain

The report revealed some interesting and actionable findings. For example, the data show that in more than half of encounters, EMS providers are omitting the complete stroke assessment, or are failing to document the assessment after a primary impression of stroke is identified. Similarly, only 75.9% of non-traumatic adult chest pain encounters received a 12-lead EKG, an area that needs attention. Conversely, EMS agencies across the nation were very diligent when it came to end-tidal CO2 monitoring, as – in almost 95% of cases – ETCO2 monitoring was initiated after advanced airway insertion.

Additionally, submitting data to a national EMS operations resource such as NEMSIS can help provide your team with performance benchmarks, gauge the efficacy of clinical interventions, and also provide valuable data for cost-benefit analyses within your agency. NEMSIS is a national information system intended to set a universal standard within the United States for prehospital care agencies, specifically in terms of standardizing language and benchmarks used by providers. Information provided to NEMSIS has four key benefits, namely: 

• providing an understanding of what’s happening in your agency and community, giving you an opportunity to modify services in support of improving public health and safety. 
• providing a way to validate whether policy or protocol changes have brought increased value to the agency. 
• empowering you to be more data-driven and confident in your decisions.
• providing tangible information needed when it’s time to request or allocate resources appropriately.

By attaching some solid data points to your team’s performance, setting standards, and monitoring and adjusting on a regular basis, you can be ready to address areas of concern and recognize strengths. You also become armed with helpful information to display the real-world value your EMS organization provides to the community. Rather than vague or subjective personal observations or operating on a gut feeling, these performance metrics empower you and your team members to make strides in both operations and outcomes, creating a safer and more efficient team.

For more insights, read our white paper 5 Key Reports for EMS Leaders.