Fire and Hospital Collaboration to Share Data

According to Ed Roth, District Chief for EMS at Atascocita Volunteer Fire Department in suburban Houston, the department’s collaboration with Kingwood Medical Center, an HCA organization, began several years ago when the EMS leadership team met with hospital staff to discuss information sharing. “We approached the hospital with the mindset that we are here to be partners in our patients’ care,” says Roth. “Egos were checked at the door. We sat around and talked about how EMS can impact patients.”

Atascocita Fire and the hospital agreed to use ESO’s health data exchange (HDE) software to create an automated method for sharing patient outcome information with EMS providers in order to close the feedback loop.

Outcome Sharing Drives Protocol Modifcations

For Atascocita Fire, that feedback loop involves a quality assurance review of records for all transported patients. Roth compares the hospital staff’s diagnosis to the primary and secondary impressions in the Atascocita Fire patient record. With HDE, Roth can even in view the results of x-rays, CT scans, and lab tests as well see what additional treatment was recommended.

“This data-sharing system allows me to get loop closure and give feedback to the crew,” says Roth. “I can let them know when they are on the right track, or if something unexpected is found, then we can go back to them and talk about it.”

Information gathered with HDE has led to protocol changes and closer collaboration with hospital staff, particularly in driving better care for patients with sepsis, stroke, or ST-segment elevation myocardial infarction (STEMI).

“EMS has very much struggled in the area of identifying sepsis,” says Roth. “We want to be aggressive in our care for sepsis patients so we wrote a sepsis protocol that was approved by the hospital.”

Now, if Atascocita Fire shows up on scene and the patient meets the sepsis criteria, they notify the hospital of a “Code Sepsis.” The call triggers the hospital to have an internist from the ICU report to the emergency room to work with the ED staff. 

Feedback Helps Identify “Teaching Moments”

After transport, when Roth sees a patient’s hospital sepsis diagnosis, he checks to confirm if his crew called a Code Sepsis. If they did not, he reviews the file and talks to the caregivers to determine why.

In one example, an Atascocita Fire paramedic described one patient as a “generally sick person,” using the primary impression “other” and symptoms such as “general weakness.” The patient was later admitted for E. coli sepsis and stayed in the hospital for six days before being released on long-term antibiotics.

Roth read through the hospital records and the EMS patient report, trying to figure out why the medics didn’t call a Code Sepsis. It turned out that rather than running a fever—one of the criteria for calling a Code Sepsis—the patient had a below-normal temperature when admitted in the emergency room.

“That case gave us a chance to talk to the team about how initially people will run a fever, but sometimes as sepsis progresses it can develop into cold shock,” says Roth. “In this case, it meant we were further behind the ball than we should be. It was a teaching moment.”

With HDE, Roth has noticed that the crews really want to know what happens to their patients.

“They’ll send me a text that says, ‘Hey Chief, I think I have septic patient, can you follow them?’” Roth says. “One nice thing with the ESO software is that they can also press a button that says ‘request clinical follow-up.’ If they do, we know they want clinical feedback on that call.”

Outcome Sharing Increases Commitment to Patient Wellness

The feedback loop developed between the hospital and Atascocita Fire has also created an opportunity for the EMS providers to see the impact they have on patient outcomes.

“Traditionally, in EMS it has always been enough to deliver the patient with a pulse. That’s not our mentality here at Atascocita,” says Roth. “Our job from the time we make patient contact until the time we turn the patient over to somebody else is to do everything we can to help return the patient to a normal status of life.”

Receiving regular feedback on what happened to patients, including their diagnoses and outcomes, “has absolutely given [EMS providers] the empowerment to say they want to be active participants in the patient’s care,” says Roth.

Data and Collaboration Increase Prehospital Treatment Options

Having access to the EMS and hospital data allowed Atascocita Fire to examine how long, on average, EMS crews are with STEMI patients and about how long those patients are at the hospital before their coronary artery blockage is removed in the cath lab. Given that the total time adds up to about an hour, a suggestion was made that Heparin and Plavix, anti-clotting medications, could be administered in the field. Roth agreed and took the idea to a hospital cardiologist and the EMS medical director, who both supported the change—Atascocita’s protocols now allow paramedics to give Heparin and Plavix, meaning patients are receiving those drugs much sooner, potentially leading to better outcomes.

Having a close, collaborative working relationship with its hospital partner has been critical for Atascocita Fire.

“We have a very supportive medical director, who really wants us to be an advocate for the patient first,” says Roth. “If the protocol doesn’t meet the patient’s needs then we are expected to meet the patient’s needs.”

The commitment to meeting patient needs has driven a number of positive changes in EMS protocol for Atascocita Fire, including more aggressively treating pain, early activation for stroke, STEMI, and sepsis, as well as administering Plavix and Heparin on scene. Roth suggests these changes reflect a mentality of thinking about all care, whether it is pre-hospital or in the hospital, as critical to patient outcomes.

“Too often, we have thought of it as ‘us’ and ‘them.’ As an industry, we have to get beyond that,” says Roth. “We have to be partners in the patient’s health. Everybody involved is invested, and taking steps like creating loop closure on patient outcomes is vital to driving improvement.”