1	EMS Quality Indicators for PA EMS Region 4 Quality Leadership Working Group Quality Improvement Program Emergency Medical Service Institute Pittsburgh, PA www.emsi.org
2	Why now? Because for the first time, an intersection of technology and know-how has allowed us to: Import state standard PCR data into Microsoft Access Perform statistically valid data analyses using “BPCHART” tool
3	Why these analyses? NOT science Low-hanging fruit Business considerations
4	Agenda Predicates Performance Practitioners
5	Common factors Four years of data (2000-2003) Almost 1.8 million records Restricted to cases in EMSI counties Emergency + non-emergency cases
6	Caveats Trend indications are hypotheses only. Simple linear trend hypotheses are included on all charts. If the phrase "There is poor evidence of a trend!!" appears on a chart, the statistical tests applied by the charting tool indicate low confidence in the validity of the trend hypothesis. The more "Special Cause Flags" on a chart, the less confidence one should have in the simple linear trend hypothesis that is indicated. Data points in the last quarter of 2003 are not reliable -- some EMSCAN submissions from that period are still outstanding. All other data points are reliable. The charts only include what is documented on EMSCAN records received by EMSI.
7	Predicates Number of cases Patient age Incident Location Incident Type Suspected Illness Response Outcome Bystander CPR
8	# incidents
9	PATIENT AGE Absolute numbers Not entered Under 5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75+ Stratified in accordance with Health Profile 2000 Demographic Data published by PA DOH Health Statistics Bureau
10	# not entered
11	# <5
12	# 5-14
13	# 15-24
14	# 25-34
15	# 35-44
16	# 45-54
17	# 55-64
18	# 65-74
19	# 75+
20	PATIENT AGE Absolute numbers Not entered Under 5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75+
21	Patient Age in years (#) summary
22	PATIENT AGE Relative numbers Not entered Under 5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75+ Stratified in accordance with Health Profile 2000 Demographic Data published by PA DOH Health Statistics Bureau
23	% not entered
24	% <5
25	% 5-14
26	% 15-24
27	% 25-34
28	% 35-44
29	% 45-54
30	% 55-64
31	% 65-74
32	% 75+
33	PATIENT AGE Relative numbers Not entered Under 5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75+
34	Patient Age in years (%) summary
35	INCIDENT LOCATION Absolute numbers Not entered Residence Traffic way, 55+ MPH Other traffic way Public place Recreation area Waterway Wilderness Hotel/Motel Bar/Restaurant Industrial Mine Office/Business Farm Acute Care Facility Clinic/Dr.’s office Extended care facility EMS Rendevous Other Unknown code
36	# not entered
37	# residence
38	# traffic way, 55+ mph
39	# other traffic way
40	# public place
41	# recreation area
42	# waterway
43	# wilderness
44	# hotel/motel
45	# bar/restaurant
46	# industrial
47	# mine
48	# office/business
49	# farm
50	# acute care facility
51	# clinic/dr.’s office
52	# extended care facility
53	# ems rendevous
54	# other
55	# (unknown code)
56	INCIDENT LOCATION Absolute numbers Not entered Residence Traffic way, 55+ MPH Other traffic way Public place Recreation area Waterway Wilderness Hotel/Motel Bar/Restaurant Industrial Mine Office/Business Farm Acute Care Facility Clinic/Dr.’s office Extended care facility EMS Rendevous Other Unknown code
57	Incident Location (#) summary
58	INCIDENT LOCATION Relative numbers Not entered Residence Traffic way, 55+ MPH Other traffic way Public place Recreation area Waterway Wilderness Hotel/Motel Bar/Restaurant Industrial Mine Office/Business Farm Acute Care Facility Clinic/Dr.’s office Extended care facility EMS Rendevous Other Unknown code
59	% not entered
60	% residence
61	% traffic way, 55+ mph
62	% other traffic way
63	% public place
64	% recreation area
65	% waterway
66	% wilderness
67	% hotel/motel
68	% industrial
69	% bar/restaurant
70	% mine
71	% office/business
72	% farm
73	% acute care facility
74	% clinic/dr.’s office
75	% extended care facility
76	% ems rendevous
77	% other
78	% (unknown code)
79	INCIDENT LOCATION Relative numbers Not entered Residence Traffic way, 55+ MPH Other traffic way Public place Recreation area Waterway Wilderness Hotel/Motel Bar/Restaurant Industrial Mine Office/Business Farm Acute Care Facility Clinic/Dr.’s office Extended care facility EMS Rendevous Other Unknown code
80	Incident Location (%) summary
81	INCIDENT TYPE Absolute numbers Not entered Assault Bicycle Bite/sting Fall Fire Inter-facility Medical Motorcycle Pedestrian Recreational vehicle Shooting Stabbing Vehicular Other
82	# not entered
83	# assaults
84	# bicycle
85	# bite/sting
86	# fall
87	# fire
88	# inter-facility
89	# medical
90	# pedestrian
91	# motorcycle
92	# recreational vehicle
93	# shooting
94	# stabbing
95	# vehicular
96	# other
97	INCIDENT TYPE Absolute numbers Not entered Assault Bicycle Bite/sting Fall Fire Inter-facility Medical Motorcycle Pedestrian Recreational vehicle Shooting Stabbing Vehicular Other
98	Incident Type (#) summary
99	INCIDENT TYPE Relative numbers Not entered Assault Bicycle Bite/sting Fall Fire Inter-facility Medical Motorcycle Pedestrian Recreational vehicle Shooting Stabbing Vehicular Other
100	% not entered
101	% assaults
102	% bicycle
103	% bite/sting
104	% fall
105	% fire
106	% medical
107	% inter-facility
108	% motorcycle
109	% recreational vehicle
110	% pedestrian
111	% shooting
112	% vehicluar
113	% stabbing
114	% other
115	INCIDENT TYPE Relative numbers Not entered Assault Bicycle Bite/sting Fall Fire Inter-facility Medical Motorcycle Pedestrian Recreational vehicle Shooting Stabbing Vehicular Other
116	Incident Type (%) summary
117	SUSPECTED ILLNESS Absolute numbers Airway obstruction Behavioral Cardiac arrest Cardiac symptoms Dehydration Diabetes Dizziness Drowning GI problem Hemorrhaging Hyperthermia Hpothermia Nausea OB/GYN Pain Paralysis Poisoning/OD Respiratory Seizure Shock Stroke Vomiting Weakness Other
118	# airway obstruction
119	# behavioral
120	# cardiac arrest
121	# cardiac symtpoms
122	# dehydration
123	# dizziness
124	# diabetes
125	# drowning
126	# gi problems
127	# hemorrhaging
128	# hyperthermia
129	# hypothermia
130	# nausea
131	# ob/gyn
132	# pain
133	# paralysis
134	# poisoning/od
135	# respiratory
136	# seizure
137	# shock
138	# stroke
139	# weakness
140	# vomiting
141	# other
142	SUSPECTED ILLNESS Absolute numbers Airway obstruction Behavioral Cardiac arrest Cardiac symptoms Dehydration Diabetes Dizziness Drowning GI problem Hemorrhaging Hyperthermia Hypothermia Nausea OB/GYN Pain Paralysis Poisoning/OD Respiratory Seizure Shock Stroke Vomiting Weakness Other
143	Suspected Illness (#) summary
144	SUSPECTED ILLNESS Relative numbers Airway obstruction Behavioral Cardiac arrest Cardiac symptoms Dehydration Diabetes Dizziness Drowning GI problem Hemorrhaging Hyperthermia Hpothermia Nausea OB/GYN Pain Paralysis Poisoning/OD Respiratory Seizure Shock Stroke Vomiting Weakness Other
145	% airway obstruction
146	% behavioral
147	% cardiac arrest
148	% cardiac symptoms
149	% dehydration
150	% diabetes
151	% dizziness
152	% drowning
153	% gi problems
154	% hemorrhaging
155	% hyperthermia
156	% hypothermia
157	% ob/gyn
158	% nausea
159	% pain
160	% paralysis
161	% poisoning/od
162	% respiratory
163	% seizure
164	% shock
165	% stroke
166	% vomiting
167	% other
168	% weakness
169	SUSPECTED ILLNESS Relative numbers Airway obstruction Behavioral Cardiac arrest Cardiac symptoms Dehydration Diabetes Dizziness Drowning GI problem Hemorrhaging Hyperthermia Hypothermia Nausea OB/GYN Pain Paralysis Poisoning/OD Respiratory Seizure Shock Stroke Vomiting Weakness Other
170	Suspected illness (%) summary
171	RESPONSE OUTCOME Absolute numbers Not entered Transported Care transferred Cancelled Refused False call No patient found P.O.V. Treated/no transport Standby DOA Other
172	# not entered
173	# care transferred
174	# transported
175	# refused
176	# cancelled
177	# no patient found
178	# false call
179	# P.O.V.
180	# treated/not transported
181	# DOA
182	# standby
183	# other
184	RESPONSE OUTCOME Absolute numbers Not entered Transported Care transferred Cancelled Refused False call No patient found P.O.V. Treated/no transport Standby DOA Other
185	Response Outcome (#) summary
186	RESPONSE OUTCOME Relative numbers Not entered Transported Care transferred Cancelled Refused False call No patient found P.O.V. Treated/no transport Standby DOA Other
187	% not entered
188	% transported
189	% care transferred
190	% cancelled
191	% refused
192	% false call
193	% no patient found
194	% P.O.V.
195	% treated/not transported
196	% DOA
197	% standby
198	% other
199	RESPONSE OUTCOME Relative numbers Not entered Transported Care transferred Cancelled Refused False call No patient found P.O.V. Treated/no transport Standby DOA Other
200	Response Outcome (%) summary
201	BYSTANDER CPR Absolute numbers Not entered Yes No Unknown
202	# cardiac arrests
203	# not entered
204	# yes
205	# no
206	# unknown
207	BYSTANDER CPR Absolute numbers Not entered Yes No Unknown
208	Bystander CPR (#) summary
209	BYSTANDER CPR Relative numbers Not entered Yes No Unknown
210	% not entered
211	% no
212	% yes
213	% unknown
214	BYSTANDER CPR Relative numbers Not entered Yes No Unknown
215	Bystander CPR (%) summary
216	Performance On-scene times for possible cardiacs “EE” trauma response times Arrest interval reporting Time-to-shock
217	ON-SCENE TIME FOR POSSIBLE CARDIACS Num possible cardiacs % w/time-on-scene <15’ % w/time-on-scene <20’ % w/time-on-scene <25’ % w/time-on-scene <30’
218	# possible cardiacs
219	% w/time-on-scene <15’
220	% w/time-on-scene <20’
221	% w/time-on-scene <25’
222	% w/time-on-scene <30’
223	“EE” TRAUMA RESPONSE TIMES (“EE” = Emergency response, Emergency transport) Median response times Num EE trauma cases (all) Num (all) with response time <15’ Num (all) with response time <12’ Num (all) with response time <9’ % (all) with response time <15’ % (all) with response time <12’ % (all) with response time <9’
224	Median response times
225	# EE trauma cases
226	% w/response time <15’
227	% w/response time <12’
228	% w/response time <9’
229	ARREST INTERVAL REPORTING Num arrest interval reports Any of the following were documented: Arrest-to-CPR time Arrest-to-defib time Arrest-to-ALS time % invalid reports “Witnessed” was: not entered No Unknown
230	# arrest interval reports
231	% invalid reports
232	“Witnessed” values
233	TIME TO SHOCK (Witnessed arrests only) Num cases where TTS is known % w/TTS known <10’ % w/TTS known <4’
234	# w/TTS known
235	% w/TTS known <4’
236	% w/TTS known <10’
237	Practitioners Supply and load Service affiliations per practitioner
238	PRACTITIONER SUPPLY & LOAD Num active EMTs Num active ALS practitioners Num cases Num cases per EMT Num cases per ALS practitioner
239	# active EMTs
240	# active ALS
241	# cases/EMT
242	# cases/ALS
243	SERVICE AFFILIATIONS PER PRACTITIONER Mean number of affiliations per EMTs Mean number affiliations per ALS practitioner
244	Mean # affils/EMT
245	Mean # affils/ALS
246	EMS Quality Indicators for PA EMS Region 4 Quality Leadership Working Group Quality Improvement Program Emergency Medical Service Institute Pittsburgh, PA www.emsi.org