Mortality and quality of care in Nordic physician-staffed emergency medical services.

BACKGROUND: Quality indicators (QI) for physician staffed emergency medical services (P-EMS) are necessary to improve service quality. Mortality can be considered the ultimate outcome QI. The process quality of care in P-EMS can be described by 15 response-specific QIs developed for these services. The most critical patients in P-EMS are presumably found among patients who die within 30 days after the P-EMS response. Securing high quality care for these patients should be a prioritized task in P-EMS quality improvement. Thus, the first aim of this study was to describe the 30-days survival in Nordic P-EMS as an expression of the outcome quality of care. The second aim was to describe the process quality of care as assessed by the 15 QIs, for patients who die within 30 days after the P-EMS response. METHODS: In this prospective observational study, P-EMSs in Finland, Sweden, Denmark, and Norway registered 30-days survival and scored the 15 QIs for their patients. The QI performance for patients who died within 30 days after the P-EMS response was assessed using established benchmarks for the applied QIs. Further, mean QI performance for the 30-days survivors and the 30-days non-survivors were compared using Chi-Square test for categorical variables and Mann-Whitney U test for continuous variables. RESULTS: We recorded 2808 responses in the study period. 30-days survival varied significantly between the four participating countries; from 89.0 to 76.1%. When assessing the quality of care for patients who die within 30 days after the P-EMS response, five out of 15 QIs met the established benchmarks. For nine out of 15 QIs, there was significant difference in mean scores between the 30 days survivors and non-survivors. CONCLUSION: In this study we have described 30-days survival as an outcome QI for P-EMS, and found significant differences between four Nordic countries. For patients who died within 30 days, the majority of the 15 QIs developed for P-EMS did not meet the benchmarks, indicating room for quality improvement. Finally, we found significant differences in QI performance between 30-days survivors and 30-days non-survivors which also might represent quality improvement opportunities.

Testing quality indicators and proposing benchmarks for physician-staffed emergency medical services: a prospective Nordic multicentre study.

OBJECTIVES: A consensus study from 2017 developed 15 response-specific quality indicators (QIs) for physician-staffed emergency medical services (P-EMS). The aim of this study was to test these QIs for important characteristics in a real clinical setting. These characteristics were feasibility, rankability, variability, actionability and documentation. We further aimed to propose benchmarks for future quality measurements in P-EMS. DESIGN: In this prospective observational study, physician-staffed helicopter emergency services registered data for the 15 QIs. The feasibility of the QIs was assessed based on the comments of the recording physicians. The other four QI characteristics were assessed by the authors. Benchmarks were proposed based on the quartiles in the dataset. SETTING: Nordic physician-staffed helicopter emergency medical services. PARTICIPANTS: 16 physician-staffed helicopter emergency services in Finland, Sweden, Denmark and Norway. RESULTS: The dataset consists of 5638 requests to the participating P-EMSs. There were 2814 requests resulting in completed responses with patient contact. All QIs were feasible to obtain. The variability of 14 out of 15 QIs was adequate. Rankability was adequate for all QIs. Actionability was assessed as being adequate for 10 QIs. Documentation was adequate for 14 QIs. Benchmarks for all QIs were proposed. CONCLUSIONS: All 15 QIs seem possible to use in everyday quality measurement and improvement. However, it seems reasonable to not analyse the QI 'Adverse Events' with a strictly quantitative approach because of a low rate of adverse events. Rather, this QI should be used to identify adverse events so that they can be analysed as sentinel events. The actionability of the QIs 'Able to respond immediately when alarmed', 'Time to arrival of P-EMS', 'Time to preferred destination', 'Provision of advanced treatment' and 'Significant logistical contribution' was assessed as being poor. Benchmarks for the QIs and a total quality score are proposed for future quality measurements.

Reporting Helicopter Emergency Medical Services in Major Incidents: A Delphi Study.

OBJECTIVE: Research on helicopter emergency medical services (HEMS) in major incidents is predominately based on case descriptions reported in a heterogeneous fashion. Uniform data reported with a consensus-based template could facilitate the collection, analysis, and exchange of experiences. This type of database presently exists for major incident reporting at www.majorincidentreporting.net. This study aimed to develop a HEMS-specific major incident template. METHODS: This Delphi study included 17 prehospital critical care physicians with current or previous HEMS experience. All participants interacted through e-mail. We asked these experts to define data variables and rank which were most important to report during an immediate prehospital medical response to a major incident. Five rounds were conducted. RESULTS: In the first round, the experts suggested 98 variables. After 5 rounds, 21 variables were determined by consensus. These variables were formatted in a template with 4 main categories: HEMS background information, the major incident characteristics relevant to HEMS, the HEMS response to the major incident, and the key lessons learned. CONCLUSION: Based on opinions from European experts, we established a consensus-based template for reporting on HEMS responses to major incidents. This template will facilitate uniformity in the collection, analysis, and exchange of experience.