Closing the Feedback Loop from Hospital to EMS
In emergency response, EMTs have traditionally focused on the immediate impression and care of a patient, rapid transport to the appropriate facility, and, finally, a successful hand off to an emergency department. EMTS do their best to ascertain symptoms and start immediate treatment if needed, but they often never knew what happened to most of the hundreds of people they see in their bus every year.
What might you have done differently if you had known the patient’s eventual outcome in the ED? What signs could have alerted you to a condition you missed? Are there any steps that might have led to more efficient treatment once they arrived at the hospital that your team might have implemented sooner?
Unfortunately, it was oftentimes impossible to answer these questions. Once the patient was taken into the care of the ED staff and you returned to your bus, you might have wondered about them often. But the lack of a true feedback loop made it difficult to know their outcome, meaning it was also impossible to learn from your mistakes or your successes. Health care providers worked in silos, and despite best intentions, typically never knew what happened before or after their role in treatment.
However, thanks to today’s data technology, EMTs are increasingly able to get insight into the cases that they work, teaming up with hospitals to engage in “bidirectional data sharing,” meaning that a hospital can automatically share back with the EMS agency information on all patients received in the ED. Software specifically designed for emergency response allows two-way communication, letting EMTs earmark specific cases they’d like follow-up on, identify areas for improvement, and tweak their protocols to support even more positive outcomes.
The Atascocita Volunteer Fire Department, located just outside of Houston, TX, was a prime example of the benefits of increased communication with the local emergency department. The Atascocita VFD averages 5,000 calls for service annually, with that number increasing as its suburban area steadily grows. The agency houses five MICU with BLS capability ambulances across the district, three of which are staffed 24/7, and also operates operates one of the state’s Mass Casualty and Mass Evacuation ambulance buses the can hold 20 patients on litters and many more seated or in wheelchairs or car seats.
In an effort to increase communication and collaboration with its local emergency department, members of the Atascocita VFD sat down with hospital staff from nearby Kingwood Medical Center to see how they could work together to improve care for their community. Ultimately, the two organizations 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.
For Atascocita VFD, that feedback loop involves a quality assurance review of records for all transported patients. The district chief regularly compares the hospital staff’s diagnosis to the primary and secondary impressions in the Atascocita Fire patient record. With HDE, the chief can go so far as easily viewing the results of x-rays, CT scans, and lab tests for a patient, as well seeing what additional treatment was recommended.
Information gathered with HDE has led to a wide range of benefits for the fire department, including 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). For example, they developed a “Code Sepsis” protocol that – once specific criteria is met – triggers the hospital to have an internist from the ICU report to the emergency room to work with the ED staff.
The ability to review patient records and outcomes also allows the chief to identify learning opportunities that come out of unique or uncommon cases. For example, the Atascocita VFD transported a patient who ended up with a diagnosis of E. coli sepsis. However, the Code Sepsis call was never made because the criteria – specifically high temperature – was never met. In fact, the patient had low body temperatures. Being able to review the case, the Atascocita EMTs discussed how sepsis can actually evolve into shock, causing low body temperatures, and meaning the infection is much more advanced. Discussions like this were an additional key benefit of the bidirectional data sharing between hospital and fire station.
By removing the walls between the silos of care – and increasing communication between EMS and hospital – health care providers can not only improve their own efficiencies and protocols, but deliver more effective, more successful outcomes to their community members.
Read the full Atascocita case study here.