In the 40 years since its first mission, STAT MedEvac has become one of America’s most prominent air-medical organizations, distinguished by its cutting-edge emergency care and clinical leadership. But that’s not all the Pennsylvania-based agency – an arm of the Center for Emergency Medicine of Western Pennsylvania (CEM) – is known for. It’s also a busy locus of emergency medical research, with physicians and educators recognized for their work and expertise. That academic orientation is a function of the CEM itself, which is directed by a consortium of five University of Pittsburgh Medical Center hospitals.
When data is your game, you’d better be adept with it, and STAT MedEvac is. The service wields some key tools to help its clinical and quality personnel evaluate performance, identify and fix issues, and produce bodies of data and analyses that help ensure quality, drive improvements and meet regulatory requirements.
“Data is the backbone of the whole thing, for everyone from our medical directors to our director of medical operations,” said Matt Kravetsky, STAT MedEvac’s performance and quality improvement coordinator. “Our director of medical operations will come over to my office and say, ‘Hey, I need this,’ and I can build him all kinds of reports he can just seamlessly pull data from.”
Two of the key tools that help enable this come from ZOLL: ZOLL emsCharts, the cloud-based ePCR software from ZOLL Data Systems that’s built to help providers complete thorough, accurate documentation that supports optimal care and reimbursement; and the RescueNet CaseReview application, which streamlines and simplifies the collection and analysis of case files from the company’s X Series monitor-defibrillators (used by STAT MedEvac) and AED 3 BLS defibrillators.
DRIVING THE CARE
If any service should be versed with ZOLL emsCharts software, it’s STAT MedEvac. The company was among its earliest adopters and has used the platform since it debuted more than 20 years ago, and its leaders – data focused then as now, Kravetsky notes – provided lots of early testing and input. “A lot of our guys were kind of paramount in building it,” he said. “We were a test bed for what was needed in a critical care platform.”
The focus of ZOLL emsCharts software is producing a quick, accurate and complete record of care in the field. STAT MedEvac uses it as part of a standardized approach to charting that helps streamline efforts and save time. The platform is designed to guide users quickly and intuitively through their charting, reducing data entry to a matter of minutes and keeping their primary focus on the patient. Slow, manual data-entry tasks are automated, and vital signs and waveforms from other devices can be imported for a complete patient picture. Its records integrate with ZOLL Dispatch and ZOLL Billing for fully holistic workflows.
“Especially with the ‘Add Actions’ and things like that in the reporting, it makes it easy to pull charts for the specific metrics we’re looking at,” said Kravetsky. “Our medical directors can pull very specific data they need and have basically automated a lot of it, which prevents a lot of manual digging in and looking around. And they’ve tweaked the analytics to where they’re getting some pretty good insight out of it.”
That’s a good start for QA/QI, but the RescueNet CaseReview application can expand the approach. It illustrates CPR quality and collected clinical data in an easy-to-read display, including important metrics like compression rate and depth, release velocity and the duration of pauses. It’s accessible from any web-capable device.
For medical directors or supervisors doing QA, comparing patients’ charts to their 12-lead files was once a tedious process that required searches based on time stamps. RescueNet CaseReview functionality in ZOLL emsCharts lets them view that case data side-by-side with their providers’ field documentation, easily highlighting discrepancies that may require coaching or remediation.
RescueNet CaseReview software enables playback of clinical information such as vital signs, clinical waveforms, CPR metrics and ventilation quality. It can be used with other charting solutions, but the one-click integration with ZOLL emsCharts ePCR software saves three to five minutes per chart. At STAT MedEvac, medical directors make good use of the comparison ability to identify improvement opportunities.
“Without it, you might never know if the charting was accurate,” Kravetsky said. “A crew member might say, ‘The pulse ox came off the finger, that’s why it looks bad.’ Then the medical director can tell them, ‘No, it was right – you can see it right here.’ So, it’s not to be punitive, but it lets us identify if the numbers were actually right, or if there was an issue with vibration or perfusion or something. And they can go through second-to-second to see, if there was an issue, how our interventions worked or didn’t work. With things like that, it really does help drive the care.”
PART OF A ROBUST PROCESS
The quality assurance process at STAT MedEvac is robust to say the least. It starts with case review meetings each Monday morning to go over notable calls from the previous week and discuss any questions or concerns raised by crews. Personnel can submit calls for follow-up, and medical department staff who do daily QA rotations can flag potential cases of interest for medical directors.
There’s also an automated latter-stage case review level where completed flights are cross-referenced for difficult and complex patients and looked back over if they haven’t been. “That’s for high-acuity patients and things we might not see often,” said Kravetsky. “We’re probably reviewing all the charts we should be reviewing, but the computers are checking us on the back end, as well.”
ZOLL emsCharts software supports this level of scrutiny in a number of ways. In the field, departments can customize and prioritize their data fields to their liking, and customized dashboards can provide real-time data and an unlimited number of user-defined reports. “You can program basically whatever you want,” said Kravetsky. It supports metrics for industry benchmarking and lets medical directors track key performance indicators.
Some of that benchmarking comes via quarterly reporting under the GAMUT (Ground and Air Medical Quality in Transport) standards, developed by a pair of top physicians to support quality care in medical transport. “They’re a good place to benchmark yourself and see how you’re doing,” said Kravetsky. “We use their metrics and benchmarks that are most applicable to critical care medicine.”
ZOLL emsCharts software also facilitates the reporting of key data elements to the states in which STAT MedEvac operates. In Pennsylvania, that’s a straightforward NEMSIS package, but Maryland and the District of Columbia both have additional requirements.
The platform is device-agnostic and can work online or off-, uploading when it reconnects. Data is easily shared bidirectionally via the ZOLL Care Exchange integration platform, linking it to hospital and health system partners, as well as state NEMSIS databases.
Those Monday meetings at STAT MedEvac are also an opportunity for the side-by-side visual comparison of patients’ PCR data with their case files via RescueNet CaseReview. Corroborating these two platforms can reveal some striking insights.
“We have a big screen on the wall where we can pull them up side by side and see, for instance, ‘The oxygen saturation was 89 here,’ then you can play the file in real time and see, ‘Hey, was that real or not? Because the waveform was completely goofy,’” said Kravetsky. “We can use that for arterial lines or pretty much any waveforms. End-tidal CO2 is a big one as well – when was the tube in? Did it dislodge? And then you can watch it and see the exact moment of the change in status.”
IMPROVED CARE AND CASH FLOW
One of the latest improvements realized at STAT MedEvac with the help of the ZOLL platforms includes checking glucose on patients with GCS scores under 15 – a GAMUT metric the service adopted. Another is sitting patients up in flight to reduce hypoxia risk, the result of a trend detected through the service’s careful review.
“Identification of trends is one of the biggest benefits we’ve seen,” said Kravetsky. “We’ve been able to identify quite a few improvement opportunities through the data we pulled out of charts.”
There’s also a benefit to revenue. The careful review and cross-referencing of PCRs helps identify and prevent potential billing errors that could result in rejected claims and delayed or lost reimbursement. Getting claims right the first time means getting paid faster.
To make the most of the joint abilities of the ZOLL emsCharts and RescueNet Case Review platforms, Kravetsky advises, start from the endpoint – the goal you want to achieve with your data efforts. Work backward from that to develop KPIs and determine what to measure.
Not only do the platforms support that, but ZOLL does too.
“If you reach out, you can bounce ideas back and forth, and they’ll be good about building you a solution around your needs,” Kravetsky said. “They have resources and can even network you with other clients doing the same kinds of things. We have the charting standardization program we’ve put together, and we’ve presented on that for them and talked to other programs about how we do ours. So if they know your needs and where you’re trying to go, they can certainly help you.”
For more information, visit ZOLL Data Systems.
ZOLL, emsCharts, RescueNet, X Series and AED 3 are registered trademarks of ZOLL Medical Corporation.
