What can be better than data to improve patient outcomes?
At least that’s the common denominator central to the 19 research posters submitted for the annual competition at NAVIGATOR 2018, and this year, two projects took top honors.
Chuck Gipson, Quality and Education Manager, MEDIC EMS, Davenport, Iowa (USA), represented his team in accepting the award for the project “Saving Brain in Stroke Patients.” Dawn Faudere, Johnson County Emergency Communications Center (JCECC), Olathe, Kansas (USA), accepted the award for the project “Implications of Pre-Alerts for Medical Emergency Calls,” representing team members from JCECC, Guilford County Emergency Services/Guilford Metro 911 (GCES), Greensboro, North Carolina (USA), and the International Academies of Emergency Dispatch® (IAED™).
Both projects took a literal “step back” in the EMS pre-alert process in proving the feasibility of dispatch’s potential role in improving patient outcomes by providing pre-alerts prior to ambulance arrival.
As defined in emergency dispatching, pre-alerts are used to send responders to calls prior to establishing a final dispatch code.
Saving Brain in Stroke Patients
In April 2014, MED-COM, the dispatch division of MEDIC EMS, launched emergency dispatcher initiated activation of stroke alerts based on results from using the Stroke Diagnostic Tool available directly from MPDS® Protocol 28: Stroke (CVA)/Transient Ischemic Attack (TIA).
Through a process involving a chain of notifications—commencing with 911—hospital stroke alert teams were activated based on emergency dispatcher actions, rather than waiting for verification from the field. According to results, emergency department notification by emergency dispatchers saved time in administering clot busting drugs to stroke patients. Findings imply that the earlier the alert activation, the better the patient outcome.
Implications of Pre-Alerts for Medical Emergency Calls
In this project, researchers looked at the costs and risks involved with pre-alerts for medical emergency calls in regard to dispatch priorities, response units, call cancellation, and call downgrading. The study analyzed data extracted from JCECC and GCES.
According to the findings, while pre-alerting can be crucial to patient outcome, it is not always the most prudent approach in emergency dispatch and response. For example, potential exists for increased risk to responders and bystanders when medical response is sent without safety and final determinant coding. Downgraded calls and cancelled units following the receipt of additional information increases costs.
Findings showed no significant change in patient outcomes (based on vital sign values), although results indicated the need for further study to compare agencies that use pre-alerts against those that do not use a pre-alerting process.
Developing a research project
Getting started is often the hardest part about research. Selecting a topic is a challenge, and the same goes for formulating a question that frames the study’s intent. A clearly defined question is necessary to data gathering and providing overall meaning to the field of interest.
Gipson chose his topic based on a potential to influence outcomes earlier in the process.
“EMDs had the information and wanted to do something more to activate help before the arrival of ambulances,” Gipson said. “The hard part was overcoming hospital resistance. Why change something that wasn’t broken?”
Studies have shown a reduction in time-to-CT and improved process measures when EMS personnel notify emergency departments of a “stroke alert” from the field. These positive predictive results from the field led to the question of whether the process could begin at the dispatch level, considering the availability and predictive value of the Stroke Diagnostic Tool.
Gipson and research partners—Linda Frederiksen, MEDIC EMS Executive Director, Brandon Miller-Guss, MED-COM Quality Supervisor, and Richard Vermeer D.O., MEDIC EMS Medical Director—analyzed three years of data collected from reports on call audit processes of EMDs, ambulance care, and hospital outcomes. Findings revealed the amount of time saved, accuracy of emergency dispatcher assessment, and patient outcomes once at the hospital.
Data proved EMD early alert activation was beneficial but approval to put a process into place hinged on approval from the two stroke-certified hospitals MEDIC EMS serves. They gave the go-ahead.
“We can only achieve the common good for patients when everybody is doing the same thing,” Gipson said. “It comes down to a process of communication. The more information we have, the better decisions hospitals can make.”