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EMS Reason for Encounter (RFE)

EMS Reason for Encounter (RFE). Greg Mears, MD FACEP Principal Investigator North Carolina EMS Medical Director University of North Carolina-Chapel Hill. RFE?. What is it? When did this idea happen? Where did the idea come from? Why do we need it? How do we get it?. What is it?.

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EMS Reason for Encounter (RFE)

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  1. EMS Reason for Encounter(RFE) Greg Mears, MD FACEP Principal Investigator North Carolina EMS Medical Director University of North Carolina-Chapel Hill

  2. RFE? • What is it? • When did this idea happen? • Where did the idea come from? • Why do we need it? • How do we get it?

  3. What is it? • Coding system for EMS • Uniform description of the reason for an EMS encounter • Not diagnostic (not mapped to ICD-9) • Based on EMS curriculum skill set • Based on NHTSA dataset • Reproducible • A calculation, not a code

  4. Reason for Encounter • Two year project • Funded by NHTSA

  5. Where did the idea come from? • Problems • Quality Management • Patient Care • EMS System • EMS Technician • EMS Outcomes • EMS Research • Surveillance • Reimbursement

  6. Example of Problem • Respiratory Distress could be: • Asthma • COPD • Pneumonia • Trauma-Chest wall contusion or pneumothx • Foreign Body • Congestive Heart Failure

  7. Same issues Quality Management Outcomes Research Surveillance Reimbursement Also System Design Information Systems Merging several systems data together National EMS Database Descriptive Information Linkage or pass through to other healthcare information systems EMS Policy and Funding Why do we need it?

  8. Final RFE Definition Purpose Method Datapoints Evaluation

  9. RFE Definition • An EMS reason for encounter is an objective description of the patient’s problem which forms the basis of EMS care, based on the compilation and/or calculation of existing EMS patient care report documentation.

  10. Purpose • The RFE serves to subdivide EMS patients into defined groups which are reproducible, independent, and usable for EMS quality management.

  11. Method • Dual Evaluation by pilot data to develop a final RFE • Cluster analysis based on all datapoints within either the NHTSA or PreMIS datasets. • Did not reveal a valid method for RFE • Treed description based on • Injury • Complaint • Location • System • Acuity • Accepted method by the Task Force

  12. Parameters • Must include all technician levels? • Must be derived from the NHTSA dataset? • The datapoints will become a component of the NHTSA dataset version 2.0 • Must conform to the EMS curriculum? • The EMS curriculum addresses each of the datapoints at all personnel levels. • The organ system data point was felt to only be valid for EMT-Paramedic level personnel • Must not require coding? • Coding is not required, only completion of the datapoints as part of normal documentation

  13. Analysis • Evaluate the models by validating the RFE with: • Provider coding of RFE • Hospital diagnosis • Mapping RFE to Hospital Diagnosis failed. • Decision: RFE must stand alone but be reproducible in the EMS community • Analysis for accuracy and reproducibility • Review of 500 NC PreMIS records which document RFE components • Multiple RFE’s per patient • To complicated for the initial project. • A single RFE per patient was determined to be the goal.

  14. RFE Data Points • Injury Present • Primary Complaint Anatomic Location • Primary Symptom • Primary Complaint Organ System

  15. Injury Present • Yes • No • Unknown • Indication whether or not there was an injury.

  16. Abdomen Back Chest Extremity-Lower Extremity-Upper General/Global Genitalia Head Neck The anatomic location of the chief (primary) complaint as identified by EMS personnel Primary Complaint Anatomic Location

  17. Bleeding Breathing Problem Change in Responsiveness Choking Death Device/Equipment Problem Diarrhea Drainage/Discharge Fever Malaise Mass/Lesion Mental/Psych Nausea/Vomiting None Pain Palpitations Rash/Itching Swelling Transport Only Weakness Wound The primary symptom present in the patient or observed by EMS personnel Primary Symptom

  18. Cardiovascular Central Nervous System Endocrine/Metabolic Gastro-intestinal Global/General Musculoskeletal Obstetrics/Gynecology Psychological Pulmonary Renal Skin The organ system of the patient chief (primary) complaint which is injured or affected, based on the evaluation of an EMT-Paramedic. Primary Complaint Organ System

  19. Verification • Large scale reliability of all EMS RFEs. • All technician levels • Rural vs. Urban • Volunteer vs. Paid • Other states, geography • No able to be completed within time frame and funding level

  20. Evaluation • 500 Records were evaluated by the PI for the following: • Completion of the Datapoints based on the review of the Ambulance Care Report • Documentation of the EMT personnel level completing the form • Identification of a Volunteer or Paid EMS Service • Population of the Service Area

  21. Evaluation Results

  22. EMS Reason for Encounter(RFE)

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