Contra Costa Health Services EMS QI Data Summary Annual Report: 2007

EMS QI Program (EQIP) Mission Statement  To ensure that quality emergency medical services are available for all people in Contra Costa County and that emergency medical care is consistent with best practices and evidence based medicine.

From Bricks to Road

Our EMS Performance Yellow Brick Road!

“Creating a Culture of Safety”  Patients  Providers  Stakeholders

Who is involved?  EMS Agency  Base-Trauma Center  Emergency Dispatch  BLS/ALS First Responders  Ground Ambulance  Air Transport  Receiving Facilities

Contra Costa EMS QI Program Partnership  Question: How are we doing?  Answer:

What we do right!  Strong Commitment to Making Things Better  Great Environment to Solve Problems!

What did QI do in 2007?  A productive year of accomplishments!

Core EQIP Indicator Reports “Our EMS System Vital Signs”  Utstein Report/Cardiac Arrest  Pediatric Report  Documentation  Trauma and Trauma Triage  Patient Safety Reporting  Airway Management  Infrequent Skills (new)  Medication Report  Chest Pain/STEMI  Pain Evaluation & Treatment  Shortness of Breath  Destination Report  AMA/Patient Refusal  General Activity (Dispatch)  Customer Satisfaction

QI Data Collection & Reporting QI studies QI studies 2008 Zoll Integration First Responder View Full View of EMS System Performance Challenges Ahead Data Warehouse Dispatch Integration ECG Transmission CARES Mapping CEMSIS Integration Report Automation Managing the Data Overload Long Term: ePCR push into Facility MEDRec

EMS Event (Patient Safety) Reporting 2007 Summary Highlights 60% of reports come from our own EMS provider agencies Analysis: Cooperation and Accountability! 60% of our EMS events communication related Strategy: Focus is on root causes not symptoms! Event Type#% Communication2460% Medication717.5% Destination1332.5% Patient Care3690% Billing12.5% Documentation- ePCR 1435% Response Time1230%

High Risk Communication  Patient Handoffs (CCCEMS 2006 Annual Report)  > 102,000 handoffs  Up 20% from 2005  2008 Goal  Improve handoff communication

Paramedic EMS Patient Safety Practices  88-94% know use of weight charts/tapes improve safety but 14.5% did not always use.  3.4% reported a safety event in the last 3 years while 30 % did not.  11.5% no cross- checking during med handoffs.  29% stated Anonymous reporting would increase patient safety reporting. CCCEMS data: Sept-Dec surveys (27% return rate)

EMS Patient Satisfaction  4685 responses  4.5% return rate  4 question survey  Confidence in skills  Communication  Service  Comfort & pain control)  Positive responses 92%  Neutral 3.5%  Negative 4.5% AMR Jan-Sept 2007

Ingestion Treatment Audit Charcoal Use and ALOC  Retrospective sample 2007  Results (41 cases)  87% Cases had charcoal given or attempted  86% no improvement or change  40% had GCS <15 or deteriorated after charcoal  Evaluation: Charcoal Risk > Benefit  QI outcome: Elimination of charcoal in treatment guidelines to improve patient safety

Documentation Delivery and Completion  Zoll  36-86% compliance  MEDS  Improved 17% since Jan 2007  Fax delivery 99.7% effective QI Expectation : Draft/complete ePCR with patient delivery. Many challenges….slower progress

2007 Field Competency: Skills How do we maintain competency? Skill# attemptsSuccess per Attempts Historical Data Bench marks IV %-- Intubation37165%70-83%80-90% Combitube14383%70-89%- External Jugular11166%-- IO24100%-- Thoracostomy17100%-- Ranked in order of frequency AMR Data from Jan-Dec 2007, Historical studies multi agency

Field Medication Utilization: Furosemide or Lasix

Pain Assessment and Management

Trauma Advanced Airway

12 Lead Field Utilization

Chest Pain

Field Airway Management AMR First Quarter 2007

EMS for Children Performance Indicators EMS-C Indicator Total N CCCEMS compliance EMSA QI Benchmark Weight Documented 80689%90% ALOC & Glucose Monitoring 1471%80% ALOC & Hypoglycemia treated 0-80% First Epinephrine dose correct by weight 567%97% Valium/Versed dosing correct by weight 580% Vascular Access and IO and trauma 28769%80% Pain assessment and pain scale documented 365%80% AMR Jun-Aug 2006 (EMSC CQI Validation Study 2007)

Kids Needing EMS Primary Impression<3y3-7y8-13y14-18yTotal N % 1. Blunt Injury % 2. Behavioral Disturbance % 3. Post-Seizure Seizure Status Epilepticus % Total pediatric patients seen by % 55 % children seen by 911 due to 3 conditions 105 pediatric patients/month (<18 yrs) 52 pediatric patients/month (<14) AMR Dec 2005-May 2007

Pediatric Field Skills Success Procedure <3 yr3-14 yr15-18 yr0-18 yr 60% % % % % 8 27% 17 26% 23 22% 48 86% 8 75% 7 0% 0 80% pedi-procedure attempts per month 0.7 pedi-procedure attempts per medic per month AMR Dec 2005-Dec 2007

Goals 2008 Improve QI information exchange Patient Safety Handoff communication QI Tool Implementation EMS Events QI Activity Reports Standardization Full compliance with Title 22 QI Improve Field Care STEMI Pediatrics Pain Skills Success

On our way …..

Questions?