Thursday, May 9, 2013

Documentation Request

I am going to use this communication medium as an opportunity to convey a request.

Nearly every call we go on involves a first responder of some sort. Some of those agencies have committed to providing an advanced level of care for the patients in their community. They are initiating care before we arrive, commonly administering medications under the medical direction of AH-EMS. We support those EMR services that want to do more, like the medications, with some stipulations around education and training.

For the most part, the only medications that the EMR services are doing are the ones outlined in the Minnesota state rule regarding "variances". The rule is for BLS ambulances services and allows them to provide glucagon, epinephrine via auto-injector, sub-lingual nitroglycerin and albuterol via nebulizer. The rule does not mention EMR services, but we use follow the letter of the rule for consistency when initiating the plans with the EMR services.

For clarification, there are no variances relating to procedures. I commonly hear people refer to an IV variance or a King airway variance. There is no rule in the legislature about those procedures. It comes down to whether or not the EMS medical director wants the group to do it. Of course, the responsible medical director would ensure proper training and review of cases.

This brings me to my main point. Two years ago, AH-EMS received a grant to study the effects of the care provided by our EMR groups. We specifically chose to evaluate the care provided by two of our groups doing advanced cares. Allina Health has a very talented group in the research consulting unit who was able to tie together the AH-EMS patient report with that of the EMR services we chose to study. They were able to link about 80% of the calls in the time period chosen. That equals about 10,000 calls where we have both the EMR report and the AH-EMS report for the same person. From a data perspective, this is great. the 20% gets lost in things like misspelled names, cancels of either party, etc.

What did we find?
That is the point of the research and it is not done yet, so you'll have to wait.

BUT, we did find out that everyone documents in a different way. Some people put EMR procedures under the activities tab, and then put "done by FR" in the comments, or just leave it under their own name with no comments. This makes it look like AH-EMS did the King,  for example, when it was the EMR who did it. This means that our data has a giant conflict because 2 groups are claiming the procedure and we can't be sure who did it.

So, here is the solution.

I ask that all of you document any EMR medications or procedures in the Prior Aid slider in the At Scene tab. That is what it is for, and we can search it with reports and know exactly who did what. We cannot search comment fields for things like " done by Bloomington PD".

So, I encourage you to change how you document EMR interventions. I know that there may be cases where it is not perfect for telling the story. But, look at what we have now. We have people using numerous ways to document the EMR care and if we are going to keep track of their work, review the cases and research it, it needs to be done in a uniform way. So let's use the Prior Aid slider in the At Scene tab.

In the name of research, I thank you.