By Chris Postiglione, MSN, MPH, RN, NREMT-P
Those of us of a certain age can remember going to the library and digging through a card catalogue or the stacks for an article (any article) that remotely met the assignment requirements. Or even better, choosing the country to write a report about based on the last Encyclopedia Britannica our parents picked up at the grocery store. I’m not sure anyone had a complete set. A paucity of data sources and the amount of effort required to gather data was the burden of Generation X, and those before it. Fast forward twenty years and the problem is quite the opposite; an avalanche of data. The challenge starts with asking the right questions and ends with interpreting the data correctly.
What data should you pay attention to? Are you measuring the right things? Are you running the correct calculations? A simple example to illustrate the importance of asking the right question is to imagine a test where five students get 100 (yay for them), five students get a 0 (boo for them) and one student gets a 90. The median test score is a 90. Wow, that is a smart class. But is it? Or would the mean be a better indicator of performance? The mean would show an average of about 53. Wow, that is a dumb class. Well, this too does not tell the total story. The next step is to look at deviation.
Scene time is an oft lauded metric in EMS operations. The lower the better! However, there is a limit to how low it can go without sacrificing the quality and attention necessary for proper, and safe, patient care. It will never go to zero. The trend over time is far more important. The measure then is not the time itself but the variation from the trend. Because entrapments and rescues can inflate scene times, a median time may be more appropriate. Variations, high or low, are neither good nor bad in and of themselves. Deviations are signals calling for more attention and examination.
Ask yourself, what behavior am I assessing and how do I want to improve or sustain it? While the outcome matters, knowing it does not leave a provider with a behavioral course of action. Breaking down the factors leading to a particular outcome into measurable behaviors provides very clear guidance to the medics on scene. Breaking down medical and operational outcomes into smaller steps also allows you to see what individual factor is driving a deviation and it if is a systemic problem or an individual provider problem. This allows for efficiency in addressing the deviation. Keep in mind you might also notice individual providers who consistently perform well. You can identify the behaviors that predict success and begin to include them in your measurement.
The intentional mercenary focus on asking the right questions is the first step in digging out from under the data avalanche. The right questions coupled with thoughtful interpretation of the answers filter out the nuggets from the noise and allow for more time improving EMS performance.