Best practices in EMS oversight needed to improve pre-hospital care

May 19, 2017, University of Michigan
Credit: Michigan Medicine

Emergency medical services are often the first to provide acute care to critically ill patients. These services can include private, government or publicly owned paramedic and ambulance services, as well as fire departments with EMS personnel.

But delivery of that care isn't always seamless. Nor are the quality levels universal.

The divide was the basis of a 2015 Institute of Medicine report that highlighted fragmentation among EMS systems in the United States and a lack of accountability and coordination at the state and federal levels.

The findings compelled Mahshid Abir, M.D., assistant professor of emergency medicine at Michigan Medicine and director of the University of Michigan Acute Care Research Unit, to evaluate the quality of EMS oversight in Michigan and explore how EMS systems could work together to improve patient care.

"This report identifies best practices in EMS oversight and informs related state policy in order to improve pre-hospital care quality," says Abir, who presented her findings at the 2017 Society for Academic Emergency Medicine annual meeting in Orlando, Florida.

In its own evaluation, the Institute of Medicine (now the National Academy of Medicine) continually cited knowledge gaps in best practices in quality measurement and data reporting for EMS oversight. It also provided recommendations to better understand what roles the federal government, state governments and local communities have in oversight and evaluation of EMS systems.

Abir and colleague Rekar Taymour, a research associate for the U-M Acute Care Research Unit, agreed with the recommendations. They sought to examine how those knowledge gaps could be filled regarding Michigan's 61 medical control authorities -

organizations that oversee and coordinate EMS in designated areas -through funding from the Michigan Department of Health and Human Services.

Michigan HHS administered previous evaluation tools and held outcomes data within the Michigan EMS Information System (MI-EMSIS), a statewide repository of EMS data that contributes to a larger national repository.

The authors' efforts were guided by their long-standing objective.

"The U-M Acute Care Research Unit works to unify the delivery of acute care along its continuum, meaning pre-hospital care, emergency care, inpatient care and ambulatory care all play a role," says Abir, also a member of the Michigan Center for Integrative Research in Critical Care and the U-M Institute for Healthcare Policy and Innovation.

Gathering and analyzing data

The study involved three phases. In the first, researchers analyzed peer-reviewed and lay literature to evaluate the landscape and quality measures of EMS oversight.

Phase two included a quantitative analysis of the MI-EMSIS to evaluate the degree to which reported data were missing.

"MI-EMSIS is meant as a quality-assessment tool for pre-hospital care," Abir says. "However, it can only be used for this purpose if the reported data is complete and valid."

Data evaluated included patient demographics, medication allergies, EMS provider impression and vital signs, among other variables.

Finally, they performed focus groups and interviews with EMS stakeholders from diverse community settings, geographic regions and professional roles to understand factors associated with successful EMS oversight.

The takeaway: Most quality measurement occurs at the EMS personnel level instead of the oversight and system levels, confirming the knowledge gap identified by the Institute of Medicine report.

Results and recommendations

Findings from Abir's study shed light on key factors to developing quality measures for EMS oversight.

The team found that the data being reported in MI-EMSIS were not always of high quality, and missing variables often differed based on software platform, EMS agency and the overseeing medical control authority. Stakeholders, the researchers note, attributed the missing data partly to data-mapping issues, uncertainty in how each authority defined some of the variables and unfamiliarity with reporting procedures.

"We took the data from the three phases of the study and triangulated it," Abir says. "We found that high-quality EMS oversight occurs through seven key factors."

The seven areas of note:

  • Competition and collaboration
  • Leadership
  • Organizational structure
  • Quality improvement culture and practice
  • Relationships and communication
  • Resources
  • Community-specific factors

Those pillars have valuable implications.

"We noted that medical control authorities have to be deliberate and have structures and processes in place in each of these seven areas," Abir says. "If they do, we think it could greatly improve the quality and coordination of care EMS systems provide to patients."

Based on the study findings, the team provided 20 recommendations to Michigan HHS to inform policy related to EMS oversight in the state.

Among them: promoting EMS protocol consistency across the state; encouraging medical control authority boards to include representation from all key stakeholders; developing and disseminating a medical control authority guidebook of best practices to EMS agencies; exploring methods of providing consistent funding to medical control authorities through hospitals, EMS agencies, foundations and private industry; and promoting regional medical control authority conferences for leaders to coordinate and collaborate.

"Unifying care across the continuum—including from the pre-hospital to emergency department and hospital settings—through improved communication and collaboration is likely to lead to improved care quality and patient outcomes," Abir says.

Looking forward

Through informing state policy regarding EMS oversight, Abir hopes the study and recommendations can help improve pre-hospital care quality and unify EMS services and other key stakeholders, and perhaps become an example for other states of how these services can work together more effectively through high-quality EMS oversight.

"Medical control authorities can serve as a common point where stakeholders across the state, including hospitals, EMS agencies and police and fire departments can come together and improve pre-hospital care and patient outcomes," Abir says. "Collaboration is key."

Explore further: ACP issues challenge to cut task burden and put patients first

Related Stories

ACP issues challenge to cut task burden and put patients first

March 28, 2017
(HealthDay)—In a position paper published online March 28 in the Annals of Internal Medicine, recommendations are presented to address the impact of administrative tasks and reduce the administrative burden on clinicians.

Researcher examines impact of quality improvement efforts in Canadian hospitals

February 15, 2017
A recent pan-Canadian research study from Queen's University has found that hospitals need to make improvement efforts a top priority and engage frontline health care professionals to be most effective in improving the quality ...

To make Medicare better for all, take social risk factors into account, experts recommend

February 8, 2017
Every day, the Medicare system pays certain doctors and hospitals a bit more, or judges them a bit differently, because their patients are sicker than national averages.

CU researchers study hospital readmissions from post-acute care facilities

January 15, 2016
Better coordination between hospitals and post-acute care facilities could reduce patient readmission to hospitals and mortality rates, according to a new study of risk factors by researchers from the University of Colorado ...

Researchers create conceptual model for acute, unscheduled care

July 7, 2016
Researchers at the George Washington University (GW) created a conceptual model for episodes of acute, unscheduled care - care that can be delivered in a variety of settings from emergency departments to doctors' offices, ...

Urgent care centers must be made ready for kids: New AAP guidelines

April 28, 2014
Today the American Academy of Pediatrics (AAP) issued an updated policy statement making recommendations and highlighting gaps in knowledge about the treatment of children in urgent care centers. Led by Gregory Conners, MD, ...

Recommended for you

Multiple screen use affects snack choices

March 19, 2018
Using multiple screen devices simultaneously while snacking may influence food choices, according to a new Michigan State University study.

Exposure to low levels of BPA during pregnancy can lead to altered brain development

March 17, 2018
New research in mice provides an explanation for how exposure to the widely used chemical bisphenol A (BPA) during pregnancy, even at levels lower than the regulated "safe" human exposure level, can lead to altered brain ...

The coffee cannabis connection

March 15, 2018
It's well known that a morning cup of joe jolts you awake. But scientists have discovered coffee affects your metabolism in dozens of other ways, including your metabolism of steroids and the neurotransmitters typically linked ...

Smoking linked with higher risk of type 2 diabetes

March 15, 2018
The prevalence of diabetes has increased almost 10-fold in China since the early 1980s, with one in 10 adults in China now affected by diabetes. Although adiposity is the major modifiable risk factor for diabetes, other research ...

Key drivers of high US healthcare spending identified

March 13, 2018
The major drivers of high healthcare costs in the U.S. appear to be higher prices for nearly everything—from physician and hospital services to diagnostic tests to pharmaceuticals—and administrative complexity.

Pedometer health boost lasts four years

March 13, 2018
Wearing a pedometer to count your daily steps can keep you healthier and more active for as long as four years after using it, a new study shows.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.