Regionalizing Emergency Care Workshop Summary (2010) / Chapter Skim
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7 Data and Communications
7 Data and Communications
Pages 95-108
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From page 95... ...
-- fully coordinate their activities and integrate communications to ensure seamless emergency and trauma services for the patient." "We have talked about the need to have regionalized systems in their response to a variety of specialty care areas," Dawson observed. "The item that remains constant in all of these is the emergency medical services system.
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From page 96... ...
In addition, the panel will focus on data and data collection, which are essential to measuring and improving the system. EMS COMMUNICATIONS CHALLENGES Kevin McGinnis, former emergency medical services director for the state of Maine and consultant to the National Association of State EMS Officials, said that he has been involved with building EMS systems since 1974.
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From page 97... ...
FIGURE 7-1 Core elements of emergency medical services systems. SOURCE: Dawson (2009)
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From page 98... ...
STANDARDIZING EMS DATA COLLECTION N Clay Mann, professor in the Department of Pediatrics at the University of Utah School of Medicine and principal investigator for the National Emergency Medical Services Information System (NEMSIS)
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From page 99... ...
NEMSIS has also had a hard time collecting data that is nonclinical. He said, "We need to reeducate our EMS folks on the importance of collecting data that would support evaluation and improvement of systems." Mann said EMS officials would like the NEMSIS data system to be able to link to associated data sets, such as automated crash-notification data, 9-1-1 call center data, and police data.
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From page 100... ...
The expert panel's findings showed that these technologies show promise in improving outcomes in severely injured crash patients by predicting the likelihood of serious injury following a crash with greater precision, decreasing response times, aiding field triage decisions regarding destination and transportation mode (ground versus air EMS) , decreasing time to definitive trauma care, and hopefully reducing deaths and disabilities.
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From page 101... ...
The way the system works, Acker explained, is that when a paramedic responds to an incident, if he or she finds a patient who meets the entry criteria for one of these three conditions, the medic calls the Trauma Communication Center (TCC) , which is staffed 24/7/365 by EMT-Ps [emergency medical technician-paramedics]
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From page 102... ...
He said, if we go the route of demonstration projects "you are going to see at least a 40 percent communication need, right off the bat." Telemedicine's Potential Bill Hanson, an intensivist who runs a telemedical intensive care unit (ICU) program from the University of Pennsylvania, said his organization has also addressed issues about whether to keep patients in place and when to move them.
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From page 103... ...
we are locked into." He added, "we think that's the greatest thing and that it's going to improve the trauma care for our rural-placed hospitals." If the Indian Health Service puts a CT in each one of its 40 hospitals, he said, and those are linked into their regional trauma centers, they could get an immediate read, which would definitely help determine the proper management plan for minor head injuries and other issues.
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From page 104... ...
He said that at a recent meeting, Saffle provided a case example of the need for telemedicine: a patient was shipped to Salt Lake City for burn care, but once the soot was removed from the patient's face, all he needed was a 79-cent tube of Bacitracin. But it had cost $15,000 to transport him, plus he was hospitalized for 2 days while his family drove from Montana to get him.
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From page 105... ...
" Medical Records and Hospital Diversion in an Air Traffic Control Model Stephen Epstein of Beth Israel Deaconess Medical Center in Boston said to Acker, "It sounds like you operate with primarily one major tertiary center, a lot of feeders into that." He said he was curious whether it would be possible to expand that system into a much larger venue where there are multiple organizations competing within a single region or metropolitan area. Referring to Magid's presentation (see Chapter 3)
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From page 106... ...
Probably the long-term solution is that there will be a national electronic health care record, and all those who participate in the care of a patient, in whatever phase, will have to stick to the standardized data set that flows into one central repository. Acker said that they had tried to establish a regional system of patient medical records, but it had failed because it relied on patients and physicians to take steps to provide the information.
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From page 107... ...
Randy Pilgrim, emergency physician and chief medical officer of a practice management firm, the Schumacher Group, said that he is involved in advocacy at the state and federal levels regarding health care reimbursement changes that support improved quality and outcomes. Pilgrim said, "Questions come up very frequently around how you drive accountability with the reimbursement structure." With regard to the Birmingham system, he said, "I get that your system [is]
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From page 108... ...
The number of hours of divert for emergency departments have decreased about 15 percent over the last four and a half years. He said they have not been able to solve their divert problem for psychiatric cases, which, he called, "a terrible problem." But, in general, we have the divert status in front of all of the hospitals all the time, Acker said, and "they literally will do everything they can do stay off of divert." However, his own view is that patient care suffers when the hospitals exceed a certain capacity -- whether it's for a trauma, stroke, STEMI, or general medical patient.
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