The “Starter Kit” of EMS Clinical Performance Measures
1. Time
· System issue:
1. Performance Measures Project ID
R8(a)
2. Question
Time of symptoms to access of 911 system
3. Proposed Indicator Name
Average Time to Access
4. Key Process Path
Operations: Response Intervals > All
5. Patient/Customer Need
Speed of access to and response of system following onset of emergency
6. Type of Measure
Process
7. Objective
Reduce all times
8. Indicator Formula
Summed differences between two date/time values divided by the number of events for which times are recorded
9. Indicator Formula
Description
Average times
10. Denominator
Number of events for which times are recorded
10.a Denominator Inclusion
Criteria
Count all events for which the values for E05-01 and E05-02 are present and pass logic test
10.b Denominator Exclusion
None
10.c Denominator Data
Sources
NEMSIS state or agency level
11. Numerator Description
Sum of time differences: value of E05-02 minus value of E05-01
11.a Numerator Inclusion
Values for E05-01 and E05-02 are present and pass logic test
11.b Numerator Exclusion
11.c Numerator Data
12. Sampling Allowed
13. Sampling Description
14. Minimum Number of
Data Points
Two plus agency/locale and time/date identifiers
15. Suggest Reporting
Format: Numerical
Minutes/seconds
16. Suggest Reporting
Format: Graphical
17. Suggest Reporting
Frequency
Monthly/Annual
18. Testing
19. Stratification
20. Stratification Options
21. Current Development
Status
22. Additional Information
23. References
24. Contributors
· Benchmark issue: time of dispatch to arrive patient
R8(b)
Time of dispatch to arrive patient
Average response time
Count all events for which values for E05-04 (time responding unit was notified by dispatch) and E05-06 (time when responding vehicle arrives on scene and stops moving) are present and pass logic test
Value of E05-06 minus value of E05-04
Values for E05-04 and E05-06 are present and pass logic test
1. Respiratory
· The percentage of patients who require respiratory support that receive it
Q6
The percentage of patients who require oxygen for respiratory support that receive it
Appropriate Oxygen Administration Rate
Clinical Care: Respiratory Management > Appropriate Oxygen Rate
Patients with respiratory compromise in the EMS setting who require oxygen
Increase rate in appropriate patients
Number of respiratory distress/arrest patients receiving oxygen in a given period divided by total respiratory distress/arrest patients in that period
Percentage of patients for whom a provider impression of respiratory distress/arrest or breathing problems is created that receive oxygen
Number of patients creating a provider impression of respiratory distress/arrest or breathing problems.
Patients with NHTSA value “799.10- Respiratory arrest” or
“786.09- Respiratory distress” for either element E09-15 or E09-16 or value 1410 - Breathing Problem for E09-13 or E09-14.
NEMSIS state level
Number of patients creating a provider impression of respiratory distress/arrest who receive oxygen
“786.09- Respiratory distress” for either element E09-15 or E09-16 or value 1410 - Breathing Problem for E09-13 or E09-14 and who have a NHTSA value for “oxygen” for element E18-03. This should also include oxygen administered prior to arrival of EMS unit (E09-01).
No
NA
Three plus agency/locale and time/date identifiers
Raw Ratio maintaining the original numbers
Monthly
· How long did it take to provide respiratory support?
How long did it take to provide respiratory support?
Average Time to Respiratory Support
Respiratory care provided
Early intervention of oxygen to improve SPO2 saturations
Decrease time it takes to apply oxygen
Time of arrival of EMS unit to the time that oxygen was applied for respiratory distress/arrest patients in a given period.
Mean average times
The number of Respiratory distress/arrest patients in which oxygen is administered and times are recorded.
Count all events for which:
Values for E05-06 and E18-01 are present and pass logic test
Value of E05-06 minus value of E18-01
Value of E05-06 and E18-01 are present and pass the logic test.
N/A
1. Accuracy
Accuracy score of PCR
Completion percentage of the PCR
Completeness of the PCR
To determine how many records have values listed in each of fields E01-01, E02-01, E02-04, E02-05, E02-12, E02-20, E03-01, E05-02, E05-04, and E05-11.
The total number of events in a given period in which there of value listed for each of elements E01-01, E02-01, E02-04, E02-05, E02-12, E02-20, E03-01, E05-02, E05-04, and E05-11 divided by the total number of events.
Look at the selected fields and determine whether all are filled in.
All reported events.
All events
NEMSIS State Level
The total number of events for which all of the values are complete for the NHTSA elements listed.
All events where there is a value for E01-01, E02-01, E02-04, E02-05, E02-12, E02-20, E03-01, E05-02, E05-04, and E05-11.
Percentage
· ALS Subset: the percentage of patients whose condition indicated ALS that actually received it
CC11
ALS Subset: the percentage of patients whose condition indicated ALS that actually received it
EKG Performance Rate
Clinical Care: ACS > EKG Lead Performance Rate
Early performance of diagnostic EKG can accelerate definitive care
Number of chest pain patients having EKG, 3 – 12 leads, in a given period divided by total chest pain patients in that period
Percentage of patients for whom a provider impression of chest pain/discomfort is created that have a 3-12 lead EKG performed
Number of patients creating a provider impression of Chest Pain /discomfort
Patients with NHTSA value “1650 786.50- Chest pain / discomfort” for either element E09-15 or E09-16. EKG performed by ALS Providers.
Patients < 18 years of age (E06-14/E06-15 - E05-02, or E06-16) . EKG is performed by someone other than ALS Providers.
Number of patients creating a provider impression of chest pain/discomfort who have an EKG (3-12 lead) performed by ALS Providers
Patients with NHTSA value “1650 786.50- Chest pain / discomfort” for element E09-15 (Primary impression) or “1785 786.50- Chest pain / discomfort” for E09-16 (Secondary impression) and have “3 -12 lead EKG” indicated in Procedures list (Performed) (D04-04) (E19-03))/89.510 – Cardiac Monitor or 89.820 - 12 lead ECG.
Patients < 18 years of age (E06-14/E06-15 – E05-04, or E06-16). EKG performed by someone other than ALS Providers
Six plus agency/locale and time/date identifiers
· BLS Subset: time to defibrillation
CC4
BLS Subset: Time to defibrillation
Time to Defibrillation
Clinical Care: ACS > Defibrillation Time
Speed of access to defibrillation when needed.
Reduce time
Time intervals from onset of V-fib to defibrillation summed for a given period, divided by the number of time intervals reported during the period
The mean average time interval from onset of V-fib, in which a patient is defibrillated, to the first defibrillation, for a given period of time.
The number of V-fib events in a given period in which defibrillation is attempted
NHTSA E19-03 has values for “defibrillation” (manual or AED) Manual Defibrillation – 99.622 and AED Defibrillation – 99.621
When data is excluded from numerator, associated event count is excluded from denominator
The time from onset of V-fib to first defibrillation
NHTSA E5-01 with E11-01 (see notes below) values of either 2240 – yes, prior to EMS arrival or 2245 – yes, after EMS arrival and E19-01 present for E19-03 “defibrillation” procedure
Values for E5-01 or E19-01 missing or fail sequence logic test.
Three plus agency/locale ID elements
Annual