When a possible heart attack strikes, time is of the essence. Quick diagnosis of the patient's status and needs while in transit can make the difference between life and death—and between a lengthy hospital stay and lengthy recovery. The problem is, it's not always that easy to tell if someone is having a heart attack.
Many, if not most, EMS providers, as independent entities, simply act on their own, do their best to stabilize the patient based on the information they are able to quickly obtain, and deposit the patient at the hospital, at which the emergency team takes over.
Often, EMS teams are not aware of some of the most current research on patient symptoms, don't have the ability to contact physicians at the hospital where the patient is to be delivered, and sometimes they simply have poor relationships with the professionals on the other end of the trip.
Derrick Suehs, chief quality officer at Crouse Hospital in Syracuse, NY, who knows such problems can cause a cascade of needlessly negative events to grow larger, decided to do something about one aspect of the problem at his hospital.
"Historically hospitals have thought of themselves from an inpatient point of view," he says. "They haven't understood the whole continuum of care to the community. But as we get closer to understanding how delivery of care and accountability are changing, we are redefining our borders and thinking differently."
Indeed they are.
It started about a year and a half ago with an attempt by Crouse and Suehs to improve the hospital's emergency department patient experience. They focused on former patients and recognized that EMS services in the area, despite being completely independent from the hospital, were key players in the delivery of the hospital's emergency services.
Suehs facilitated "listening sessions" with 10-12 different EMS providers from central to upper New York. He asked them questions about how the hospital interacts with them, what it does well, what it doesn't do well, and what they wished the hospital would do that it didn't do currently.
The conversation was enlightening and eye-opening, he says. He heard some difficult comments:
- The ED staff was rude.
- It was taking too long to offload the patient into the hospital.
- The physicians didn't communicate very well with the EMS providers. They never found out what happened to the patient after they'd left.
Suehs and others representing Crouse in the listening sessions promised to work on those issues. The collaboration could have ended there, but as relationships developed with those in charge of quality on the EMS side, they thought they might be able to make a bigger difference.
Suehs got a meeting with the chief quality officer of the largest EMS service in the area. What came out of it? "What if we actually did a quality initiative together?" Suehs says.
The biggest area of opportunity, he explains, involved cardiac care, simply because those exhibiting symptoms of cardiac distress were the lion's share of those transported to the hospital for treatment. At the top of the list was finding a way to improve communication between the hospital and EMS providers so that patient care could be improved.
Along the way, they developed an entirely new treatment protocol.
"All this is being done simply by talking between the ED physician and EMS transporters," Suehs says. "Cardiologists can determine in real time what condition the heart is in and be prepared for that diagnostic event.
Improving communication is one thing, but here's where it gets really interesting: Suehs and his colleagues took a close look at the most serious and significant heart attacks and studied the use of EKG leads.
It turns out that about a third of the patients who were actually having a heart attack did not complain of chest pains. Results showed that limiting pre-hospital EKG testing only to patients who complain of chest pain can significantly delay diagnosis and negatively impact treatment time.
As a result of this combined research, Crouse physicians and the EMS service decided that they should do ambulance-based EKGs on patients who complained of other symptoms besides chest pain.
"As a result, we changed protocols," says Suehs. "This is a way to find more effective ways to push treatment of the patient further into the field while they're en route."
As Suehs points out, there are a number of reasons to do this kind of work, but making sure care provided is efficient and as quick as possible will have a positive impact down the road, not only for the patient but for the hospital as well, as they are increasingly held responsible through a variety of mechanisms for longer than average lengths of stay.
"But the main beneficiary is our patient—that is, collectively ours—the hospital's and the EMS service's. The mental attitude dividing line is disappearing. They actually get to learn more from the physicians, who are taking time to teach them clinically what's going on with their patients, which makes them a better EMT."
As a result of the success of the cardiac program, Crouse is seeking a grant to do some of the same type of educational and research work for suspected stroke victims, Suehs says.
Given the amount of waste and lack of connectivity that plagues healthcare today, I can't think of too many better ways to spend a little grant money.
Philip Betbeze is the senior leadership editor at HealthLeaders.