Expediting vital patient information

“Call 911!” a wife hears her husband shout. He’s fallen from the roof and is lying bleeding on the ground. Within seconds, it seems, a North County Fire Protection District fire truck rolls up the driveway, an ambulance right behind. At once paramedics hover over her injured husband, assessing his injuries, giving aid. Another paramedic pulls a hand-held Hewlett Packard Personal Digital Assistant (PDA) from his breast pocket and calmly records their progress and her husband’s vital information.

“What are you doing?” the wife asks, gesturing at the device. “I’m documenting everything that I’ve done; making a detailed report of your husband’s emergency care for the ER nurse,” the paramedic responds. “We started this June 6. It’s more accurate, faster,” he says, then jumps in the ambulance to transport her husband to the hospital. As the injured husband is being rolled into the ER, the paramedic beams the PDA at a printer in the ER and instantly a hard copy of the details, called a Pre-Hospital Care Report, is in the nurse’s hand.

North County Fire Protection District adopted the state-of-the art medical emergency call reporting procedure this month to enhance patient care. By using the preprogrammed PDA, a paramedic or an emergency medical technician (EMT) can select various medical choices based on a patient’s emergency needs then display them in a print-ready narrative report. The technology eliminates a lengthy, two-page handwritten document in use for years. Illegible handwriting on the old report documents often caused delays and confusion, says Chief Milt Davies, but no more.

Using the PDA assures more accurate documentation, says firefighter-paramedic Brent Itzaina. “It documents everything we have to say on a call without having to worry about sloppy handwriting.” Itzaina is the point man for instructing other NCFPD personnel on the new procedure. All 30 paramedics and 38 EMTs associated with NCFPD now use the technology. It is also widely used throughout San Diego County. Itzaina says writing up reports with the old format took him from 15 minutes to half an hour. “This [the PDA] on average takes me 10 to 12 minutes to do the same task.” Expediting recordkeeping frees up paramedics and EMTs for their next call. Once the call is complete, paramedics and EMTs use the PDA to download the information onto the secure NCFPD server, where it’s reviewed by administration for quality assurance and billing. Retaining the information electronically also reduces physical storage. Itzaina hefts an 11- by 14-inch accordion folder stuffed to capacity to illustrate. “This is two weeks’ worth,” he says. Using the new technology enables NCFPD to replace the weighty storage with paperless call reports. In addition to the former two-page call document, paramedics and EMTs also prepared three other reports, all of which had to be completed in sequence to finalize the call. The PDA takes care of all that, too. Itzaina recalls a recent transport to Tri-City Hospital: “By the time we arrived, I only had to ask the driver for the mileage and my reports were done. When we returned to Fallbrook, I was ready for my next call.” He says he can now complete a report in five to seven minutes.

Billing and quality assurance are two other areas where use of the new PDA technology improves operations for the NCFPD. “We collect about 51 percent of what we bill out,” says Chief Davies, “and there’s a direct correlation between our ability to read the old forms and the medical coder to print an accurate bill in a timely manner.” Davies says he will be interested to see if the collection percentage increases now that legible records are kept. “Even if it is one to two percent, if pushed it out over five years, we’ve recouped the cost of the equipment.” North County Fire Protection District funded the $40,000 purchase price for the PDA technology out of their General Budget.

Davies also points out the old form did not provide timely quality assurance records. It took two years before reports were generated for review by administration. Electronically stored reports are instantly accessible, so Davies and other administrators can monitor standard operating procedures for paramedics and EMTs to determine how well policies are being followed. In addition to administration oversight, NCFPD also has peer-driven quality assurance. If a peer discusses a breakdown in procedure with you it’s easier to accept, Davies says. Quality assurance goes much further, too. “We can also understand what kind of patient population we have,” he adds. “We can see what type of injuries or illnesses are prevalent.” This knowledge makes the paramedics and EMTs more prepared. “We can query the data to find out who we are and what we’re doing. We can get more timely and accurate billing going out and hopefully improve that revenue stream.”

Making the North County Fire Protection District emergency medical calls more efficient, timely and cost-effective may be their goal, but the wife whose husband rides safely to the ER with a concerned paramedic or EMT on board knows the real benefit of the technology.