HD72 - Management of Patient Care Reports in Virginia's Pre-Hospital Setting


Executive Summary:
The 1997 General Assembly requested that the State Emergency Medical Services (EMS) Advisory Board conduct a pilot study to help assess the performance of Virginia's EMS system and to assist in planning future policy and funding. In accordance with HJR 637 guidelines, 50 EMS agencies, representing each of the Office of EMS's eight regions, were invited to participate in a study of the Management of Pre-Hospital Patient Care Reports in Virginia's PreHospital Setting. The selection included volunteer, paid, rural and urban agencies. They were offered an incentive of $100 each for providing copies of their PPCR forms relating to cardiac arrest calls for three months (April 1996, November 1996 and January 1997). Five additional agencies were identified as alternates.

The State EMS Advisory Board charged the Office of OEMS with the coordination of this pilot study. The Office of EMS contracted with Virginia Health Information, Inc., (VHI) for tabulation, analysis and reporting of the data obtained from the PPCR forms. Tabulation and analysis were conducted so results were given as comparisons and statistical significance. Participation by EMS agencies in the pilot study was moderate as 39 of the 55 agencies selected (70.9%) sent in their PPCR data for the three months requested.

Significant findings of the study showed that:

• An effective system does not exist to tabulate statewide information on emergency services runs, e.g., response times, transport times, outcomes or the nature of the calls, and what percentage of the calls are cardiac, burn or accident related.

• Analysis of the data did provide valuable information to measure response and transport times and the results of emergency calls, and help identify deficiencies that need to be addressed. It would also provide agency and technician information on medical direction for Operational Medical Directors. Information not currently available that could be critical to localities and the state in seeking federal grants could be provided.

• Based on the small amount of error in data entry (less than 2%), the information given is promising in reflection of the type of further studies that could be done within data entry for EMS. Further projects with larger sampling sizes could provide useful information on pre-hospital cardiac arrest patients or other medical issues, as well as performance information on individual EMS agencies and the Virginia EMS system.

• The "snapshot" information gathered from this study can be used to initiate the development of a practical approach to gather the information needed to increase survival rates.

Due to the small size, limited time frame and data entry constraints of this pilot study, major changes in EMS life support policies and procedures on either a state or local level are not recommended. The Office of EMS should continue to stress the implementation and/or continuation of quality assurance and improvement programs within EMS agencies in order to ensure that PPCR forms are accurately and completely filled out. This recommendation may help to alleviate any inaccurate information that gets keyed into other programs that may be developed. It would also help to identify any patient care issues that may arise.

The study determined that further analysis needs to be conducted to address the following questions:

* What is the purpose of collecting the pre-hospital care data - monitor performance, allocate resources, research, legal record keeping, policy development?

* What is the feasibility of developing a unified PPCR reporting and evaluation system?

* What is the most efficient and effective way to collect input, analyze data and assure data quality?

* What type of incentives can help assure participation and cooperation by EMS agencies?

* What effect will their participation and the development of a unified data entry system have on EMS agencies?