PCR Use Study 2007 San Mateo

PCR Use and ED Information Handoff Survey : 

PCR Use and ED Information Handoff Survey Benjamin Schooley, MBA, PhD

Purpose : 

Purpose To begin to develop an improved system (process, procedures, data systems) for “handing off” patient information from pre-hospital to hospital care givers. The challenge: “Trade off is difficult - Medical Info for ED and need to get back in service. We need to find a way to solve this.” - EMS Administrator

Goals : 

Goals Improve the pre-hospital – hospital information (PCR) handoff in a way that enables timely delivery but does not sacrifice quality of care. Develop a method and process for measuring performance

Objectives : 

Objectives To take a systematic approach to determine the current state of practice in California for using Patient Care Records (PCR) in the pre-hospital setting and in the ED, and to determine if and where a “best practices” scenario exists. What are the processes? (scribe, abbreviated PCR) What are the policies? (time to completion)

Procedures : 

Procedures Start with the “what” questions and then drill down 20 Question Survey Developed Input from San Mateo EMS Agency www.surveymonkey.com Invitation sent out to all California EMS Administrators and Medical Directors via email

Who Responded? : 

Who Responded? 41 responses Representing 28 of 31 California EMS Systems 17 EMS Administrators/Directors 13 Medical Directors 2 Program Managers 2 Data System Analysts 1 EMS Physician 6 Not specified

Who Completes a PCR : 

Who Completes a PCR

Paper vs. Electronic : 

Paper vs. Electronic Comments from respondents: 10 counties are in the process of moving to system-wide electronic PCR systems 5 counties reported the use of paper in the case the electronic system fails 4 Counties use paper (Orange, LA, SF, El Dorado) – are all migrating to electronic

PCR System Ownership : 

PCR System Ownership Other: fill-in answers discussed joint ownership arrangements between two or more organizations.

PCR Software Satisfaction : 

PCR Software Satisfaction

Who Completes and Submits a PCR? : 

Who Completes and Submits a PCR? Other: Radio operator, care giver

Scribe? : 

Scribe? Monterey, Contra Costa, Orange, Santa Cruz, Nor Cal, Santa Clara, Sacramento

Maximum time Ambulance May Remain at Hospital : 

Maximum time Ambulance May Remain at Hospital “enough time to complete the task” “until required to respond to another call”

Time Extensions Allowed? : 

Time Extensions Allowed?

Time Frame to Complete PCR : 

Time Frame to Complete PCR Wide variation with fill-in answers. Ranged from approx. 5 min. to approx. 10 hours

Patient Delivery & PCR : 

Patient Delivery & PCR What are your compliance rates? Not enforced, 40%, 75%, 88%, 90%, 99% >88% - Kern, SF, El Dorado, Alameda, Santa Cruz, Marin

Abbreviated PCR : 

Abbreviated PCR

Abbreviated PCR : 

Abbreviated PCR Alameda, Nor Cal, Contra Costa, Santa Clara, Sacramento, San Joaquin, Coastal Valleys

Abbreviated PCR Data Field Types : 

Abbreviated PCR Data Field Types

Abbreviated PCR Data Field Types : 

Abbreviated PCR Data Field Types

Satisfied with Process/Procedures : 

Satisfied with Process/Procedures

Satisfaction with both PCR and Process/Procedures : 

Satisfaction with both PCR and Process/Procedures Very Satisfied – Very Satisfied San Luis Obispo, Sacramento Very Satisfied – Satisfied Imperial, North Coast, Nor Cal (electronic only) Satisfied – Satisfied Inland, Solano, Santa Barbara, Kern None of these use paper based systems only. Most of them are in the process of expanding ePCR systems 3 allow for abbreviated PCRs 1 allows for a scribe 2 have time limits for ambulance staying at hospital 5 have methods for determining compliance with PCR submission requirements

Findings: General : 

Findings: General Wide deployment of ePCR systems at varying stages Wide variability in the hand-off process/procedures/policies Little known about how to measure and improve the process Yet… Agreement that this is an area that needs improvement Every CA system willing to improve/benchmark

Desire to Improve the Process : 

Desire to Improve the Process “Our method of determination has been one we arrived at in the EMS agency, but are looking for a…better process since it now only measures time the PCR is completed (sent to server wirelessly) rather than verifying delivery at hospital.” – Medical Director

Findings: For Benchmarking : 

Findings: For Benchmarking California EMS Systems identified for: Abbreviated PCR use Information types gathered Use of a scribe Use of electronic PCR vs. paper vs. both Method for determination and high compliance with hand-off processes Level of satisfaction with PCR and hand-off process

Next Steps : 

Next Steps Engage select California Counties in benchmarking studies in areas of interest (e.g., ePCR system use, use of scribe, use of abbreviated PCR, methods for tracking performance). May be valuable to look outside of California Develop method for measuring the “time of PCR submission” within San Mateo