Abstract
Introduction: Northwell Health Center for Emergency Medical Services (CEMS) strives to provide the best prehospital care in the Northeast Region. CEMS Communications, an Accredited Center of Excellence with the IAED, continually monitors the effect of its MPDS system as it applies to our EMS response through Clinical and Communication Quality Assurance and Quality Improvement.
Objective: The objective of this study was to evaluate MPDS cases handled on Protocol 26 Sick Person (Specific Diagnosis) and compare these with our paramedics' Provider Impressions. The evaluation of this data will look to validate the use of Protocol 26 for non-specific and general sick cases, and evaluate the number of Provider Impression Protocol Outliers. The data collected will help determine whether use of Protocol 26 was correct when utilized for the patient's initial Chief Complaint.
Special Definitions: Provider Impression: The paramedic's presumptive diagnosis based on their evaluation of the patients symptoms. There are Primary, Secondary and Tertiary fields within the EMR. Electronic Medical Record (EMR): Electronic patient care report used by Paramedics to document patient history, evaluation, vitals, interventions and pertinent medical information. Provider Impression Protocol Outlier: A documented impression that could be more appropriately handled on a Chief Complaint other than Protocol 26.
Methods: Using our Electronic Medical Record (EMR) system in conjunction with ProQA data, QA staff searched 14,584 records of emergency (MPDS) requests from July 1st 2016 through December 31st 2016. Those calls that generated an EMD code under Protocol 26: Sick Person (Specific Diagnosis) were filtered for further evaluation. The initial report returned 3,082 cases (with dispatch determinants in the Omega, Alpha, Bravo, Charlie and Delta levels). After reviewing the cases for application to this study, 776 were removed. Those removed from the study did not apply for the following reasons: not transported by CEMS unit and no access to a patient care report (417), calls coded as 26B1 (*335), inconclusive data (7), shunt or move to a more appropriate protocol (5), duplicate assignment (4), no Provider Impression documented (4), ambulance unit flagged (2) and inter-hospital transfers (2). The remaining 2,306 cases were tabled by EMD code with the paramedic's clinical findings. *When evaluating the application of the Provider Impression to the 335 Bravo cases, EMD-Q's found these cases to be non-applicable due to the insufficient information available in Key Questions.
Results: The 2,306 remaining cases were categorized into 49 Provider Impressions that were documented in the Electronic Medical Record. The Provider Impressions were then tabled by number of cases and Determinant Levels in each. In reviewing the application of Protocol 26 against CEMS Paramedics Provider Impressions, the study resulted in 2,021 cases, or 87.64%, that were found to be applicable to the EMD's selection of Protocol 26. Provider Impression Protocol Outliers totaled 285 cases, or 12.36%.
Conclusions: Pending IRB approval, further research will be conducted to look at the hospital reports for these patients and further analyze findings based on admitting diagnosis, length of stay, patient outcome and discharge diagnosis.