FIRE & EMS BLOGGERS
ALL IN ONE NETWORK!
A CULTURE OF QUALITY
>>Was their “decisional capacity” described in the narrative?
The 150-character test was designed to address the providers’
tendency to write a three-word narrative as the only description on
calls where crews had spent significant time with patients. “
Decisional capacity” describes the ability of someone to consent to or
Paramedics in Pinellas County were also trained to conduct a comprehensive EMS Cognitive Evaluation that could be used to help
determine if a patient has the decisional capacity to refuse transport.
REVIEWING PAST PERFORMANCE
At the beginning of the improvement project, Pinellas County performed a baseline analysis of the system’s past performance based on
these criteria and found that overall adherence to the guidelines was
low, hovering around 10%.
On some individual criterion within the bundle of care—
narratives longer than 150 characters, acquiring witness signatures, a final
Glasgow score of 15, and documenting chief complaint, history, meds,
allergies—performance exceeded 80%.
But field providers were obtaining two sets of vital signs less than
10% of the time and “decisional capacity” was described in the PCR
less than 20% of the time.
Analyzing this earlier data allowed the medical director and 19
organizations to focus improvement efforts on the two parts of their
refusal bundle that needed the most attention.
The FirstPass system automatically reviews all PCRs for compliance to the appropriate protocols, including refusals. (See Figure 1)
The Pinellas County EMS system produces thousands of patient
refusal PCRs each month. When one or more of the seven criteria
listed previously aren’t met, the report is flagged for review by the
The patient care report in this case was flagged because it was missing a second set of vital signs. You can also see that this paramedic documents two sets of vital signs
and at least one Glasgow coma scale 81.48% of the time, while the entire system meets this criterion 86.43% of the time.
Figure 1: PCR flagged by QI software