Toolkits Improving EMS Performance and Outcomes

To improve the quality of care patients receive in crisis situations, The Duke Endowment granted more than $5.5 million between 2004 and 2007 to help strengthen emergency medical services in North Carolina and South Carolina.

Insights

Standardized, Comprehensive Data Important to Improvements

Standardized, comprehensive data on emergency medical services events can help providers improve their performance on key measures and enhance their quality of care. We used three key strategies in our EMS grants. We invite others to use these findings as a starting point for their own efforts.

1. Establishing a standardized system to capture EMS data helps build performance and improve care.
2. Allowing emergency medical services providers to compare their performance to peers and statewide averages helps provide context and fuels positive change.
3. Teaming with experts to create online toolkits helps ensure that the recommendations are relevant and accurate.

Best Practices for Emergency Medical Service Providers

After analyzing performance data, we identified several characteristics of high-performing EMS providers. The EMS Toolkits are designed to help all EMS systems follow best practices, including:

• A 911 center that can locate calls — including from cell phones — to better direct providers to where they're needed.
• An emergency medical dispatch program that has diagnostic software to help identify medical conditions, dispatch an ambulance within 1.5 minutes of a 911 call at least 90 percent of the time, and help coach the caller before an ambulance arrives.
• Ambulances in appropriate locations and available at all times so they can be en route to events within three minutes of dispatch at least 90 percent of the time.
• An emergency response with the correct crew, equipment and supplies within 13 minutes at least 90 percent of the time.

EMS Toolkits

The EMS toolkits developed through these projects have served multiple purposes. We've found them to be valuable for:

• Creating a standard method for ongoing evaluation.
• Helping to monitor and address EMS educational needs.
• Providing real data and comparisons to prove the need for additional funding (example: additional staffed ambulance).
• Helping to prioritize advocacy, funding, education and policy initiatives within the state.

Impact

Improving Care with Centralized Database System

Efforts to improve the performance of emergency medical services providers are resulting in better patient care in North Carolina and South Carolina. A centralized database system being used in both states is enabling EMS systems to record data on emergency events and receive customized recommendations for improvement.

By 2007, all 100 EMS systems in North Carolina had begun using the database system and had accessed the EMS toolkits at least twice. By 2009, more than 65 percent of EMS agencies in South Carolina had received training and were beginning to use the database system, with more expected to undergo training by the end of the year. The centralized database system now contains detailed information on more than 3.2 million emergency events in North Carolina and South Carolina, and continues to grow.

New Practices Have Positive Impact on Performance

EMS systems in both states have implemented policies and procedures based on the toolkit recommendations, improving:

• EMS dispatch time
• EMS chute time
• Data quality and integration
• Data quality and completion tools
• System Design
• Ambulance placement studies and implementation
• Vehicle deployment studies and implementation

Faster Response Time

Endowment grants to individual service providers in 28 North Carolina counties have helped reduce the time from the first ring of the 911 call:

• 12 percent improvement in time from 911 ring to dispatching EMS
• 11 percent improvement in time from 911 ring to ambulance being en route
• 8 percent improvement in time from 911 ring to arriving on the scene

EMS systems in both North Carolina and South Carolina who received support from The Duke Endowment have been able to reduce their response times by an average of 3 minutes 38 seconds, which is estimated to save over 100 lives annually.

EMS Project a Model for National Improvements

The EMS project is receiving national and international attention. As a result of this work, North Carolina is one of the first five states to begin providing data to create a national EMS database. The national project is coordinated by the EMS Performance Improvement Center and the National EMS Information System.

The framework for analysis developed for the EMS toolkits is being used to create national web-based reports from the National EMS Database and is becoming a resource for EMS agencies and organizations nationwide.

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Vice President
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