Abstract WP37: Way Beyond the Call: An Extended Collaborative Feedback Project With EMS

Abstract

Background/Purpose: Emergency Medical Services (EMS) providers assess, treat and transport patients to destinations that provide the most appropriate emergency care. EMS provides the first crucial link in the chain of survival for patients suffering from life-threatening conditions. Stroke is a time-sensitive emergent condition which requires urgent evaluation, treatment, and expeditious transport to stroke-specialty centers. We noticed that EMS was not providing us with important information that could impact our initial stroke care. Our 21-month collaborative feedback project was created to provide EMS personnel who frequent our Emergency Department (ED) the tools necessary to administer high-quality, expeditious care. Our goal was to improve information provided to the stroke team and ED upon patient arrival by improving and sustaining three metrics by 20% within a 21-month period, by providing feedback to EMS, which include last known well time (LKWT), caregiver contact information (CCI), and mLAPSS documented (mLAPSS). Methods/Implementation: We collaborated with the Beverly Hills Fire Department (BHFD) educators from July of 2021 through March of 2023, providing a continual feedback loop for all EMS runs with an adjudication of stroke and TIA. Our feedback tool included quality metrics with benchmarks determined by the Los Angeles County EMS Agency, in conjunction with the BHFD educators and our team. We performed chart reviews and extracted data pertinent to each run. We summarized the hospital course and disposition for each patient and the feedback tool was distributed to the EMS providers for review. Data was collected and analyzed over seven quarters (Q3 and Q4 of 2021, Q1-Q4 of 2022, and Q1 of 2023, respectively). Results/Conclusions: Sustained improvements were noted in documentation. We achieved 20% improvement in LKWT (from 78% in Q3-Q4 2021, 98% in Q1-4 2022, 98% in Q1 2023), CCI collected (from 29% in Q3-Q4 2021, 75% in Q1-4 2022, 100% in Q1 2023), and mLAPSS completion was 8% improvement (from 89% in Q3-Q4 2021, 97% in Q1-4 2022, 100% in Q1 2023). An unanticipated result of this project was a halo effect of improved destination decisions from EMS. We will continue to track and trend these metrics and work closely with our colleagues in EMS.