Hospitals and physicians continue to partner in record numbers as they face regulatory pressures and learn the benefits of coordinated care. Hospitals can benefit from a partnership with physicians by standardizing care practices, which reduces variability and improves quality, and by gaining patient volume, which generates revenue.
Emergency medical services can also influence hospital volume and quality of care. For example, EMS is a valuable partner in the coordinated care of acute stroke patients, as many stroke patients arrive at the hospital by being transported by EMS to a hospital ED. However, partnerships between hospitals and EMS staff may not receive as much attention as partnerships with physicians.
Timothy Shephard, PhD, vice president of Bon Secours Virginia Health System's Neuroscience Institute, explains why hospitals should partner with EMS, particularly when developing a stroke team.
Involve EMS in stroke program planning
A hospital developing a stroke program should involve EMS staff in the early stages of planning as they can provide insight on the best methods to transport stroke patients to the hospital as quickly as possible. In addition, educating EMS about a hospital's stroke program makes them aware of the hospital's enhanced capabilities and may influence their choice of where to bring a patient.
Including EMS staff in the planning phase "engages EMS and integrates their input on how best to communicate from the field to the ED," Dr. Shephard says. "It is mutually beneficial to provide information about your program design and patient outcomes back to EMS leadership and the teams in field."
Many states have initiated legislation or protocols that support the EMS decision to bring stroke patients to the closest primary stroke center, which may mean bypassing hospitals without this service. However, if two hospitals with stroke centers are equidistant, the facility that has been transparent with information and supportive and inclusive of EMS talent may establish their site as a preferred EMS transport destination, Dr. Shephard says.
Opportunities for partnership
Hospitals should involve EMS staff in planning a stroke program by inviting them to committee meetings and soliciting their input on the best ways to identify patients as stroke victims. EMS can tap into neurology and ED physician expertise to design protocols to guide the dispatch operators to ask the best questions to identify acute and atypical stroke symptoms and guide the decision as to the emergent nature of the EMS response (i.e., lights and siren), according to Dr. Shephard. Hospitals can learn from EMS how to effectively communicate with their teams and what educational opportunities hospitals can provide to support EMS staff members' work.
Hospitals should share data on their ED work-up and response times to stroke patients to validate their capabilities. "If you demonstrate to your EMS that the acute stroke patient they transport to your hospital is rapidly assessed, diagnosed and treated, they're going to be more comfortable bringing patients to you," Dr. Shephard says. Sharing data on recombinant tissue plasminogen activator rates and EMS' response times can also be instructive for EMS.
Dr. Shephard says one way hospitals can share this data is by creating one-page outcomes reports that include a picture of the patient's CT scan, the EMS squad that transported the patient, the patient's signs and symptoms, the timeframe of treatment and the patient outcome. These reports would have to deidentify patient information and be compliant with HIPAA regulations.
By closely partnering with EMS on stroke care, hospitals can decrease transport times, improve outcomes and increase acute and complex patient volume. Hospitals could expand this partnership to involve heart attack care or other conditions, which would bring the benefits of improved quality to a larger percent of the patient population. As hospitals become financially accountable for population health, collaborating with community providers such as EMS will become more important.
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Emergency medical services can also influence hospital volume and quality of care. For example, EMS is a valuable partner in the coordinated care of acute stroke patients, as many stroke patients arrive at the hospital by being transported by EMS to a hospital ED. However, partnerships between hospitals and EMS staff may not receive as much attention as partnerships with physicians.
Timothy Shephard, PhD, vice president of Bon Secours Virginia Health System's Neuroscience Institute, explains why hospitals should partner with EMS, particularly when developing a stroke team.
Involve EMS in stroke program planning
A hospital developing a stroke program should involve EMS staff in the early stages of planning as they can provide insight on the best methods to transport stroke patients to the hospital as quickly as possible. In addition, educating EMS about a hospital's stroke program makes them aware of the hospital's enhanced capabilities and may influence their choice of where to bring a patient.
Including EMS staff in the planning phase "engages EMS and integrates their input on how best to communicate from the field to the ED," Dr. Shephard says. "It is mutually beneficial to provide information about your program design and patient outcomes back to EMS leadership and the teams in field."
Many states have initiated legislation or protocols that support the EMS decision to bring stroke patients to the closest primary stroke center, which may mean bypassing hospitals without this service. However, if two hospitals with stroke centers are equidistant, the facility that has been transparent with information and supportive and inclusive of EMS talent may establish their site as a preferred EMS transport destination, Dr. Shephard says.
Opportunities for partnership
Hospitals should involve EMS staff in planning a stroke program by inviting them to committee meetings and soliciting their input on the best ways to identify patients as stroke victims. EMS can tap into neurology and ED physician expertise to design protocols to guide the dispatch operators to ask the best questions to identify acute and atypical stroke symptoms and guide the decision as to the emergent nature of the EMS response (i.e., lights and siren), according to Dr. Shephard. Hospitals can learn from EMS how to effectively communicate with their teams and what educational opportunities hospitals can provide to support EMS staff members' work.
Hospitals should share data on their ED work-up and response times to stroke patients to validate their capabilities. "If you demonstrate to your EMS that the acute stroke patient they transport to your hospital is rapidly assessed, diagnosed and treated, they're going to be more comfortable bringing patients to you," Dr. Shephard says. Sharing data on recombinant tissue plasminogen activator rates and EMS' response times can also be instructive for EMS.
Dr. Shephard says one way hospitals can share this data is by creating one-page outcomes reports that include a picture of the patient's CT scan, the EMS squad that transported the patient, the patient's signs and symptoms, the timeframe of treatment and the patient outcome. These reports would have to deidentify patient information and be compliant with HIPAA regulations.
By closely partnering with EMS on stroke care, hospitals can decrease transport times, improve outcomes and increase acute and complex patient volume. Hospitals could expand this partnership to involve heart attack care or other conditions, which would bring the benefits of improved quality to a larger percent of the patient population. As hospitals become financially accountable for population health, collaborating with community providers such as EMS will become more important.
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