Why Hospitals Should Care About Improving EMS Relationships

When a patient picks up the phone to call 911, the clock starts ticking. As the ambulance arrives and the EMS team goes to work, healthcare begins and does not stop until after long after he or she has arrived in the emergency department for diagnosis and treatment.

Unfortunately, there are often some roadblocks between the working relationship of EMS and hospitals. An “us versus them” mentality can cause a divide, leaving EMS feeling underappreciated and hospital staff feeling overstressed. EMS transport values start to dip and practices between the two organizations lack cohesiveness.

So why should hospitals care?

In a presentation at the ESO Wave 2019 conference, Robert Frakes – NRP, CCP, and EMS Coordinator for the Sisters of Charity of Leavenworth (SCL) Health System – offered several practical reasons, as well as tips for improving the working relationship between hospital and EMS.

A Worthwhile Investment

“Although it’s not always recognized, EMS is one of a hospital’s biggest clients and brings in a substantial amount of revenue,” Frakes explained. “Unless a patient specifically requests a certain facility, it is up to the EMS agency to pick the transport destination. Improving your relationship with your local EMS agencies should be viewed not as an expense but as an investment.”

Frakes offered several data points showing how a positive working relationship with local EMS agencies can have a major impact on a hospital’s bottom line. For example, an average of 20-30% of patients in the emergency department arrives via ambulance. However, of these, a higher percentage are admitted (the national average is 39%), with an average cost exceeding $21,000 per visit. Additionally, when an EMS agency chooses your hospital for their higher acuity patients – such as trauma, cardiac, and stroke – the average patient cost is driven even higher.

Frakes also noted that many of the measures that impact a hospital’s rating can also be impacted by Emergency Department-EMS handoff. Hospitals are often graded on door-to-needle time, door-to-cath time, and minutes spent on assessments and screens. Utilizing the EHR completed by the paramedics can save nurses and physicians valuable time, freeing them up to ask only clarifying questions as needed. Honoring cathlab alerts and meeting the ambulance at the door shows that the ED staff trusts and takes EMS alerts seriously.

“All of these small actions show them that you view them as equals, because they really are. An ambulance is an emergency department on wheels, and they are out in the elements, diagnosing and treating these patients to the best of their ability,” explained Frakes. “An ‘us versus them’ mentality does no one any good; we must change the culture and accept that we are all health care providers regardless of title. We must build trust.”

4 Steps for Improvement

Frakes outlined several additional steps that can help build a teamwork mentality, increase EMS transports to your facility, and overall improve the working relationship with local EMS agencies.

1. Improve the Feedback Loop: Offering timely access to patient outcomes not only highlights successes and areas for improvement but actively helps educate the team. Reviewing final diagnosis and treatment can help EMS see if their impressions and field diagnosis were accurate, or if there was something they missed that they can learn from for future calls. Software tools that provide bidirectional information sharing can instantly send patient records back to EMS as soon as a record is completed in the ED. Additionally, some hospitals go so far as letting EMS teams observe in the cathlab or watch other procedures, offering an additional opportunity for education and experience.
2. Make an efficient environment. Consider small ways that can improve the experience for the EMS team when they enter your ED. Is it a maze to get to your receiving area? Ensure that your lead nurse is easy to identify, and consider making your Level 1 beds the ones closest to the door. Prove that your hospital is high quality and a place where an EMT would want to take his or her own family member if they needed medical treatment. These small actions can help EMS feel they are working with a well-controlled ED.
3. Optimize bedside handoff. Meeting the EMS team at the door with a nurse and a physician whenever possible not only improves efficiency but shows respect for the EMS team. This allows the physician to hear the report directly from the paramedics and EMTs, and to ask clarifying questions. This also gives the medics a chance to learn and create better assessments based on the doctor’s questions. This immediate education cannot be replicated in the classroom.
4. Change the culture. Get to know your EMS agencies on a more personal level, taking time to learn first names, regardless of title. Work to shift your view of EMS as “something that brings more work,” to appreciate the work they’ve done in transporting the patient to you, recording vitals and impressions, and giving you a head start on your diagnosis and treatment.

Frakes explained that his own health system went so far as to create a “Heroes’ Lounge” in its Denver location, where EMS, fire, and police can stop to get free snacks, small meals, drinks, and take time to complete paperwork or simply visit with hospital staff between calls. He notes that while the setup and maintenance of the lounge does represent some cost to the hospital, it is easily made up by the delivery of just a few high-acuity calls.

The Results

“We have seen a $4 million increase in revenue over the last two years, just from changing our culture. We attribute much of this to increased admission rates from our EMS transports as well more higher acuity patients being delivered to our facilities,” Frakes said. “Our EMS agencies know that when coming to our facilities, they will be treated as equals, be shown respect and appreciation, and, more importantly, receive timely and helpful clinical feedback.”

Investing in your relationship with your local EMS agencies can not only create a more efficient environment and better patient outcomes but make a real difference in your hospital’s revenue numbers. Improving the teamwork between the two teams is a win-win situation that will undoubtedly benefit your operations for years to come.