How is Your System Really Performing, Right Now?
For the first time there is an automated system that alerts when a patient care report doesn’t match your agency’s protocols. Years in development from the trusted EMS innovators at FirstWatch®, the FirstPass®; quality enhancement module has now processed more than 1 million ePCR records, from 4 different ePCR vendors, and has performed more than 30 million tests for deviations from protocol. What used to take days or weeks can now be accomplished in minutes, allowing agencies to take immediate action to correct documentation errors or to provide positive feedback and training.
10 Years of Evolution
What is FirstPass?
The traditional approach to Quality Improvement in EMS is labor intensive, time consuming and often confusing, leaving little time to actually improve care. EMS agencies need the ability to monitor and analyze patient care data, identifying deviations rapidly, consistently and automatically. These tasks used to take days or weeks, involving stacks of records, multiple data entry procedures and reports that were always a month late. With the advent of electronic data capture, data can now be collected in minutes and reviewed quickly and without data loss due to entry errors.
The same capabilities that allow EMS to be so well-positioned with regard to quality improvement also allow data to be collected and reviewed in a much more timely fashion than traditional medicine. Within minutes, FirstPass can review the entire patient experience from the time 911 is called to delivery at the hospital. Most importantly, quality improvement managers can now focus on actually improving the delivery of EMS rather than the collection, entry and analysis of data. Beyond these clinical aspects, improving the quality, collection and analysis of data improves billing and financial recovery.
FirstPass is a clinical quality measurement and protocol monitoring tool designed to alert users to deviations in expected treatments to medical protocols. FirstPass provides continuous monitoring of ePCR and other data to quickly identify and provide real-time alerts related to protocol deviations, incomplete “care bundles” (which include scientifically validated patient care protocols), missing data elements or urgent patient safety issues. A standard bundle of protocols are designed to measure predefined quality metrics; protocols are configured with quality metrics, yet the agency has the ability to add metrics specific to their needs. The goal is not just quality improvement; it is the quality of care to the patient.
The FirstPass “Bundle of Care” includes the following protocols: ACS/STEMI, Stroke, Trauma, Airway Management, Cardiac Arrest, Universal and Billing. Additional metrics to consider might be: Pain Management, Patient Care Aspect, High Risk/Low Frequency Event or Non-Transports/Refusals.
Real-Time Automated QA/QI
Use one tool to measure protocol compliance, documentation quality and patient outcomes
Measure Protocol Compliance
Prioritize and monitor the protocols that are most important to your system
Enhance Documentation Quality
Real-time review of completion of required patient information fields
Provide Meaningful Feedback
Real-time information allows you to ask questions and provide medics with feedback during their shift, if needed
Save Time & Resources
Let the computer do the work, save human time for what is most important
Monitor Medic Performance
Track individual medic performance to overall system performance objectives
These are indicators that are common measures across EMS systems and are readily comparable among systems. Examples include response times and cardiac arrest survival.
These evidence-based clinical measures have been endorsed or are emerging as best practices and have shown value to the patient population when performed correctly. An example of this would be ST segment elevated myocardial infarction (STEMI).
These are evidence-based and best practice measures that reduce the patient’s risk of preventable harm as well as reduce risk to the system as a whole. Examples of this include airway management and narcotics management.
How efficient is the system as a whole? Considerations include unit hour utilization, billing cycle, penalties, cost per capita, billing information completeness, etc.
FirstPass is an add-on, enhancement module that sits on top of FirstWatch. FirstWatch is the foundation for which the data is derived, where you define the things you want to look at and calls are pulled based on user-defined filters. FirstPass then takes that data through a very structured process of algorithms and logic to evaluate specific quality oriented protocols, tests and outcomes. A queue based tool, FirstPass allows members of QA/QI, risk management and the medical director’s office to all access and work through one singular quality improvement tool.
Providing that the data source (CAD, ePCR, ProQA, Hospital Data etc.) FirstWatch is interfaced with captures relevant data that can be used to evaluate against your systems protocols, FirstPass can have a high degree of customization. Once a customer defines what they want to measure, we can build custom protocols that look for quality metrics driven by customer focused initiatives as well as regional or state level mandates.
While FirstPass is highly customizable, we recommend starting with our “Bundle of Care” approach as envisioned by our Medical Director, Dr. Alex Garza. This initial set of evidence based protocols is designed to encompass recognized standards of care, the affordable care act and overall best practices. The bundle of care is divided into four components: system performance measures, clinical performance measures, patient/safety risk reduction performance measures, and financial performance measures. For more information on this approach, please contact our sales team.
The overarching goal of FirstPass is to provide automated data analysis for clinical indicators and quality measures – all in real-time, at your fingertips. With FirstPass, QA/QI teams can now spend more time working to improve patient outcomes rather than filtering through every patient record to locate potential outliers that could indicate opportunities for improvement in patient care. FirstPass automates a process that is traditionally time, resources and labor intensive; you will now know right away when a call is outside the expected parameters occurs.
Real-time feedback and knowledge of what is happening within your system at all times allows for collaboration amongst crew members, managers, QI/QA analysts, the Medical Director and any other stakeholders involved. Ultimately, this will result in rewarding success to crew members for a job well done and improving patient outcomes by focusing on areas of improvement and continuing education in a timely and continuous manner.
More and more agencies are being forced to do more with less time, money and resources. This imposes limitations on systems and their ability to adequately measure, monitor and improve their patient care processes. FirstPass is suited for any agency that is recording patient care and interventions in a digital format such as ePCR. Agencies using FirstPass vary from county EMS systems, local/private EMS providers to fire department EMS providers. Some leading EMS innovators using FirstPass include but are not limited to: St. Charles Community Ambulance District, Sedgwick County EMS, Metro Atlanta Ambulance Service and North Shore Long Island Jewish Health System.
FirstPass customers are using this tool within the “Bundle of Care” approach, or customizing protocol unique to their agency’s needs. Customers are using the FirstPass tool to look at things like risk management, billing compliance, universal treatments or if a patient was treated but not transported, to name a few. Some agencies interfaced with both ePCR and Hospital data are able to use FirstPass for the beginning of outcome reporting.
Healthcare is moving to quality measurement, bringing with it improved patient care – and financial implications. Simply stated, the components of the Affordable Care Act are directly related to controlling cost through a focus on quality of care. The same quality measures that are driving change in healthcare will soon be coming to EMS. Progressive EMS agencies are monitoring, measuring and managing quality to improve patient care and ensure success when financial incentives become realities. FirstPass helps to agencies to define, automate and streamline their measures and monitor in a timely, consistent and reliable manner. This will allow systems to make corrections and demonstrate timely and effective care through the tracking of patient satisfaction and outcomes in real-time.