Evaluating EMS Door-to-CT Times Using an EMR Based Communication Tool

2.50
Hdl Handle:
http://hdl.handle.net/10755/623700
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Evaluating EMS Door-to-CT Times Using an EMR Based Communication Tool
Author(s):
Rankin, Christopher
Lead Author STTI Affiliation:
Non-member
Author Details:
Christopher Rankin, MSN, RN, NREMT, CEN
Abstract:

Poster presentation

Session H presented Saturday, September 16, 2017

Purpose: Evidence-based standards of care in EMS and emergency nursing are well defined in clinical populations.  Communication between pre-hospital and emergency departments (ED) required improvement by accrediting organizations at our hospital.  The purpose of this IRB exempt quality improvement initiative was to compare the transcripts of calls with staff using an EMR evidence-based stroke template with those who using the template during calls to observe the effect on stroke-activation and door-to-CT times.

Design: This quality improvement process involved developing and implementing an EMR based stroke reporting template, facilitating evidence-based structured reports with EMS providers, measuring the effect of these changes quality indicators, and including EMS reports into the EMR. Each squad was asked for the time of symptom onset, Cincinnati assessment, glucose, 12-lead, and if an IV was placed. All nursing staff and paramedics were trained in the use of the template. Staff were requested, but not required to use the stroke template. All EMS calls are recorded, and patients with subsequent stroke activation were reviewed. The door-to-CT completion and average door-to-activation times were included.

Setting: This QI suburban level 2-trauma center ED based in Northeast Ohio connected to a major regional hospital system that receives 14,400 EMS calls and approximately 10,000 referring provider calls annually. Calls average 100 seconds in length, the majority received between 1100-1900 hours. The ED’s EMS catchment area includes many large retirement facilities.

Participants/Subjects: This QI project reviewed all patients who arrived to the ED via EMS with subsequent stroke activation. All ED nurses and paramedics were educated.

Methods: Nationally recognized quality markers were included for patients arriving via EMS with stroke activation.  Stroke cases were reviewed for the inclusion of symptom onset, recorded/documented stroke assessment, and evaluation of differential diagnoses.  19 Cases were excluded as inter-facility transfers, outside of the therapeutic window, incomplete documentation, misleading pre-notification, trauma, or were full arrests.

Results/Outcomes: 51 patients were included in the study with an even split between those who used the template and those who did not.  Results were measured every two weeks for eight weeks with the average door-to-activation times ranging from 1 to 4.25 minutes after arrival vs. 6.8 to 9.5 minutes post-arrival when the template was used.  Staff using the template approximately halved the Door-to-CT time and had a signficant value of p < 0.05. Five patients exceeded the 25 minute door-to-CT time set by the AHA in non-template users compared with none in the template using population.  Pre-hospital information is now permanently documented in the EMR. Staff satisfaction with pre-hospital report and triage decision-making has improved.

Implications: Early identification and reduction of stroke intervention time are known to improve patient mortality. Triage compliance for quality indicators can be enhanced and pre-hospital information permanently documented in the EMR by having trained emergency nurses hold EMS teams accountable for evidence-based standards of care. This quality improvement process has been shown improve patient outcomes and established a permanent record from EMS. Further, larger studies should be conducted on EMS call structure to measure improved triage, time to final testing, and patient outcomes.

Keywords:
Stroke; Performance Improvement; Emergency Department
Repository Posting Date:
5-Dec-2017
Date of Publication:
5-Dec-2017
Conference Date:
2017
Conference Name:
Emergency Nursing 2017
Conference Host:
Emergency Nurses Association
Conference Location:
St. Louis, Missouri, USA
Description:
ENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missouri
Note:
Items submitted to a conference/event were evaluated/peer-reviewed at the time of abstract submission to the event. No other peer-review was provided prior to submission to the Henderson Repository, unless otherwise noted.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleEvaluating EMS Door-to-CT Times Using an EMR Based Communication Toolen_US
dc.contributor.authorRankin, Christopheren
dc.contributor.departmentNon-memberen
dc.author.detailsChristopher Rankin, MSN, RN, NREMT, CENen
dc.identifier.urihttp://hdl.handle.net/10755/623700-
dc.description.abstract<p>Poster presentation</p> <p>Session H presented Saturday, September 16, 2017</p> <p>Purpose: Evidence-based standards of care in EMS and emergency nursing are well defined in clinical populations.  Communication between pre-hospital and emergency departments (ED) required improvement by accrediting organizations at our hospital.  The purpose of this IRB exempt quality improvement initiative was to compare the transcripts of calls with staff using an EMR evidence-based stroke template with those who using the template during calls to observe the effect on stroke-activation and door-to-CT times.</p> <p>Design: This quality improvement process involved developing and implementing an EMR based stroke reporting template, facilitating evidence-based structured reports with EMS providers, measuring the effect of these changes quality indicators, and including EMS reports into the EMR. Each squad was asked for the time of symptom onset, Cincinnati assessment, glucose, 12-lead, and if an IV was placed. All nursing staff and paramedics were trained in the use of the template. Staff were requested, but not required to use the stroke template. All EMS calls are recorded, and patients with subsequent stroke activation were reviewed. The door-to-CT completion and average door-to-activation times were included.</p> <p>Setting: This QI suburban level 2-trauma center ED based in Northeast Ohio connected to a major regional hospital system that receives 14,400 EMS calls and approximately 10,000 referring provider calls annually. Calls average 100 seconds in length, the majority received between 1100-1900 hours. The ED’s EMS catchment area includes many large retirement facilities.</p> <p>Participants/Subjects: This QI project reviewed all patients who arrived to the ED via EMS with subsequent stroke activation. All ED nurses and paramedics were educated.</p> <p>Methods: Nationally recognized quality markers were included for patients arriving via EMS with stroke activation.  Stroke cases were reviewed for the inclusion of symptom onset, recorded/documented stroke assessment, and evaluation of differential diagnoses.  19 Cases were excluded as inter-facility transfers, outside of the therapeutic window, incomplete documentation, misleading pre-notification, trauma, or were full arrests.</p> <p>Results/Outcomes: 51 patients were included in the study with an even split between those who used the template and those who did not.  Results were measured every two weeks for eight weeks with the average door-to-activation times ranging from 1 to 4.25 minutes after arrival vs. 6.8 to 9.5 minutes post-arrival when the template was used.  Staff using the template approximately halved the Door-to-CT time and had a signficant value of p < 0.05. Five patients exceeded the 25 minute door-to-CT time set by the AHA in non-template users compared with none in the template using population.  Pre-hospital information is now permanently documented in the EMR. Staff satisfaction with pre-hospital report and triage decision-making has improved.</p> <p>Implications: Early identification and reduction of stroke intervention time are known to improve patient mortality. Triage compliance for quality indicators can be enhanced and pre-hospital information permanently documented in the EMR by having trained emergency nurses hold EMS teams accountable for evidence-based standards of care. This quality improvement process has been shown improve patient outcomes and established a permanent record from EMS. Further, larger studies should be conducted on EMS call structure to measure improved triage, time to final testing, and patient outcomes.</p>en
dc.subjectStrokeen
dc.subjectPerformance Improvementen
dc.subjectEmergency Departmenten
dc.date.available2017-12-05T21:31:02Z-
dc.date.issued2017-12-05-
dc.date.accessioned2017-12-05T21:31:02Z-
dc.conference.date2017en
dc.conference.nameEmergency Nursing 2017en
dc.conference.hostEmergency Nurses Associationen
dc.conference.locationSt. Louis, Missouri, USAen
dc.descriptionENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missourien
dc.description.noteItems submitted to a conference/event were evaluated/peer-reviewed at the time of abstract submission to the event. No other peer-review was provided prior to submission to the Henderson Repository, unless otherwise noted.-
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