Measuring quality and effectiveness of prehospital ems
TL;DR: Traditional efforts to assure quality in EMS systems are examined, while assessing the need to go beyond the traditional to establish measurable indicators of system quality.
About: This article is published in Prehospital Emergency Care.The article was published on 1999-01-01. It has received 99 citations till now. The article focuses on the topics: Health care & Emergency medical services.
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TL;DR: Today’s global EMS has advanced so much that it contributes widely to the overall function of health care systems and the World Health Organization regards EMS systems as an integral part of any effective and functional health care system.
Abstract: An Emergency Medical Service (EMS) can be defined as “a comprehensive system which provides the arrangements of personnel, facilities and equipment for the effective, coordinated and timely delivery of health and safety services to victims of sudden illness or injury.” 1 The aim of EMS focuses on providing timely care to victims of sudden and life-threatening injuries or emergencies in order to prevent needless mortality or long-term morbidity. The function of EMS can be simplified into four main components; accessing emergency care, care in the community, care en route, and care upon arrival to receiving care at the health care facility. 2 Today’s global EMS has advanced so much that it contributes widely to the overall function of health care systems. The World Health Organization regards EMS systems as an integral part of any effective and functional health care system. 3 It is the first point of contact for the majority of people to health care services during emergencies and life-threatening injuries and act as a gate-keeping step for accessing secondary and tertiary services. Emergency medical providers around the world have developed an extended role to deal with medical and trauma emergencies utilizing advanced clinical technology. In many countries where proper EMS system exists, providers can administer controlled medications such morphine and epinephrine, perform invasive procedures for instance, endotracheal intubation and placement of intravenous line, and make complex clinical judgment or even pronounce death. 4,5 The rapid development of medical technology has also reformed the international EMS systems with the introduction of multifunctional compact monitoring systems making the task of monitoring patients manageable in an uncontrolled environment of pre-hospital settings. Since 1970s, the mode of emergency health care delivery in pre-hospital environment evolved around two main models of EMS with distinct features. These are the Anglo-American and the Franco-German model. These categorical distinctions were obvious during the 1970s until the end of the 20th century. Today, most EMS systems around the world have varied compositions from each model. The delivery of emergency medical services in pre-hospital settings can be categorized broadly into Franco-German or Anglo
147 citations
TL;DR: A simulation model was designed and the following alternatives provided the greatest combination of effectiveness, quality patient care, and cost-efficiency: establish a specific rescue protocol for the two-tier system that preassigns two network hospitals to each of the 36 EMS subgroups along with a prearranged calling sequence.
84 citations
Cites background from "Measuring quality and effectiveness..."
...The 1973 Emergency Services Act defined emergency services as ‘‘[a] system that provides for the arrangement of personnel, facilities, and equipment for the effective and coordinated delivery of health care services under emergency conditions and that is administered by a public or non-profit entity with authority and the resources to provide effective administration of the system’’ [15]....
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Journal Article•
TL;DR: This document is seeking support for elevating the science of EMS and prehospital care to the next level and research is essential to ensure that the best possible patient care is provided in the prehospital setting.
76 citations
TL;DR: Routine prospective data collection of prehospital emergency interventions and monitoring of activity was feasible over time and add to the understanding of determinants of PEMS use and need to be considered to plan use of emergency health services in the near future.
Abstract: The number of requests to pre-hospital emergency medical services (PEMS) has increased in Europe over the last 20 years, but epidemiology of PEMS interventions has little be investigated. The aim of this analysis was to describe time trends of PEMS activity in a region of western Switzerland. Use of data routinely and prospectively collected for PEMS intervention in the Canton of Vaud, Switzerland, from 2001 to 2010. This Swiss Canton comprises approximately 10% of the whole Swiss population. We observed a 40% increase in the number of requests to PEMS between 2001 and 2010. The overall rate of requests was 35/1000 inhabitants for ambulance services and 10/1000 for medical interventions (SMUR), with the highest rate among people aged ≥ 80. Most frequent reasons for the intervention were related to medical problems, predominantly unconsciousness, chest pain respiratory distress, or cardiac arrest, whereas severe trauma interventions decreased over time. Overall, 89% were alive after 48 h. The survival rate after 48 h increased regularly for cardiac arrest or myocardial infarction. Routine prospective data collection of prehospital emergency interventions and monitoring of activity was feasible over time. The results we found add to the understanding of determinants of PEMS use and need to be considered to plan use of emergency health services in the near future. More comprehensive analysis of the quality of services and patient safety supported by indicators are also required, which might help to develop prehospital emergency services and new processes of care.
74 citations
Cites background from "Measuring quality and effectiveness..."
...However, benchmarking of quality indicators are not easy to achieve, due to the multitude of PEMS organisations all over the world [11-13]....
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TL;DR: Nine percent of paramedics responding to an anonymous survey reported medication errors in the past 12 months, with 4% of these errors never having been reported in the CQI process.
74 citations
References
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Book•
31 Dec 1969
TL;DR: This chapter discusses the construction of Inquiry, the science of inquiry, and the role of data in the design of research.
Abstract: Part I: AN INTRODUCTION TO INQUIRY. 1. Human Inquiry and Science. 2. Paradigms, Theory, and Social Research. 3. The Ethics and Politics of Social Research. Part II: THE STRUCTURING OF INQUIRY: QUANTITATIVE AND QUALITATIVE. 4. Research Design. 5. Conceptualization, Operationalization, and Measurement. 6. Indexes, Scales, and Typologies. 7. The Logic of Sampling. Part III: MODES OF OPERATION: QUANTITATIVE AND QUALITATIVE. 8. Experiments. 9. Survey Research. 10. Qualitative Field Research. 11. Unobtrusive Research. 12. Evaluation Research. Part IV: ANALYSIS OF DATA: QUANTITATIVE AND QUALITATIVE. 13. Qualitative Data Analysis. 14. Quantitative Data Analysis. 15. The Logic of Multivariate Analysis. 16. Statistical Analyses. 17. Reading and Writing Social Research. APPENDICES. A. Using the Library. B. GSS Household Enumeration Questionnaire. C. Random Numbers. D. Distribution of Chi Square. E. Normal Curve Areas. F. Estimated Sampling Error. Preface. Acknowledgments.
14,990 citations
Book•
07 Dec 1989TL;DR: In this article, the authors propose three basic concepts: devising the items, selecting the items and selecting the responses, from items to scales, reliability and validity of the responses.
Abstract: 1. Introduction 2. Basic concepts 3. Devising the items 4. Scaling responses 5. Selecting the items 6. Biases in responding 7. From items to scales 8. Reliability 9. Generalizability theory 10. Validity 11. Measuring change 12. Item response theory 13. Methods of administration 14. Ethical considerations 15. Reporting test results Appendices
9,316 citations
TL;DR: Assessing quality depends on whether one assesses only the performance of practitioners or also the contributions of patients and of the health care system, on how broadly health and responsibility for health are defined, and on whether the maximally effective or optimally effective care is sought.
Abstract: Before assessment can begin we must decide how quality is to be defined and that depends on whether one assesses only the performance of practitioners or also the contributions of patients and of the health care system; on how broadly health and responsibility for health are defined; on whether the maximally effective or optimally effective care is sought; and on whether individual or social preferences define the optimum. We also need detailed information about the causal linkages among the structural attributes of the settings in which care occurs, the processes of care, and the outcomes of care. Specifying the components or outcomes of care to be sampled, formulating the appropriate criteria and standards, and obtaining the necessary information are the steps that follow. Though we know much about assessing quality, much remains to be known. (JAMA1988;260:1743-1748)
5,353 citations
TL;DR: A graphic model that describes survival from sudden out-of-hospital cardiac arrest as a function of time intervals to critical prehospital interventions is developed and is useful in planning community EMS programs, comparing EMS systems, and showing how different arrival times within a system affect survival rate.
1,150 citations