5 Questions on Systems of Care for Time Sensitive Emergencies

Senior officials in local government (e.g., city managers, county administrators, and elected officials) are in a unique position to bring about significant and measurable improvements in how medical care is delivered to patients with high-risk time-sensitive emergency medical conditions – like heart attack and stroke. In these situations, patient survival is closely related to the time it takes from onset of the condition to getting definitive treatment from a specialized care team an appropriately qualified hospital. This does not happen without considerable planning, coordination and consensus support from the many healthcare provider organizations in the region that impact care for these high-risk emergencies.

Here are five questions that senior officials in local government should ask to assess the current status of systems of care for common high-risk, time-sensitive emergency conditions (i.e., major trauma; serious heart attacks; strokes caused by blot clots [ischemic strokes]; cardiac arrest; and sepsis):

  1. Does your community/region have processes to regularly gather data from all of the EMS providers and hospitals to measure the time from onset of the specified time-sensitive emergencies to definitive care in the hospital as well as the survival rates?
  2. How does your community’s/region’s average times from onset to definitive care and survival rates compare to goals set by national professional societies for the specified conditions?
  3. Are there regular meetings of all EMS providers and hospitals (e.g., monthly or quarterly) to review the latest results on these time intervals, survival rates and other performance measures as part of a community/regional quality improvement program?
  4. Can they show you a simple graph of the average time intervals from onset to definitive hospital care for these conditions over the last 3-5 years? Do they have similar graphs of survival rates?
  5. Can EMS or hospital leaders describe any quality improvement projects at a community/regional level that have led to reductions in the time intervals or increases in the survival rates for any of specified conditions?

As important as the answers to these questions are, the conversations and efforts that these questions can lead to are just as important. Senior officials in local government are not only in a position to engage senior EMS and hospital officials in these conversations, but to assist them in making progress towards more positive replies. For example, if regular meetings of all EMS provider organizations and hospitals are not taking place, senior local officials can be extremely effective in bringing these groups together into the same room and asking for a commitment to make progress in response to these vital five questions.

Mic Gunderson is a GovLoop Featured Contributor. He has been involved in emergency healthcare for over 40 years in various leadership, educational, and clinical roles. Currently, he is the President of the Center for Systems Improvement where he provides consulting and training services related to emergency systems of care and EMS systems. Read his posts here.

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Sherin Shibu

These are great questions Mic! I’d like to know more about how these questions were applied in an actual situation. Also, how often should officials sit down and go through the questions?

Mic Gunderson

These questions would typically be used in a self-assessment where the city manager or other senior official is asking questions of the 9-1-1 managers, EMS directors, fire chiefs, and hospital administrators in the community. Their replies will show where gaps are and hopefully trigger efforts to address those gaps. Coming back the questions every year would help assess the impact of any initiatives that were started after the previous review.
— Mic