Measures should evaluate the performance of individual providers within the system, as well as that of the system as a whole. Measures should also be sensitive to the interdependence among the components of the system; for example, EMS response times may be adversely affected by ED diversions.

Furthermore, because an episode of emergency and trauma care can span multiple settings, each of which can have a significant impact on the final outcome, it is important that patient-level data from each setting be captured and combined. Currently it is difficult to piece together an episode of emergency and trauma care. To address this need, states should develop guidelines for the sharing of patient-level data from dispatch through post–hospital release. The federal government should support such efforts by sponsoring the development of model procedures that can be adopted by states to minimize their administrative costs and liability exposure as a result of sharing these data.

Measurement of Performance

Performance data should be collected on a regular basis from all of the emergency and trauma care providers in a community. Over time, emerging technologies may support more simplified and streamlined data collection methods, such as wireless transmission of clinical data and direct links to patient electronic health records. However, these types of technical upgrades would likely require federal financial support, and EMS personnel would have to be persuaded to transition from paper-based run records, which are less amenable to efficient performance measurement. The collected data should be tabulated in ways that can be used to measure, report on, and benchmark system performance, generating information useful for ongoing feedback and process improvement. Using their regulatory authority over health care services, states should play a lead role in collecting and analyzing these performance data.

While a full-blown data collection and performance measurement and reporting system is the desired ultimate outcome, the committee believes a handful of key indicators of regional system performance should be collected and promulgated as soon as possible. These could include, for example, indicators of 9-1-1 call processing times, EMS response times for critical calls, and ambulance diversions. In addition, consensus measurement of EMS outcomes could be applied to two to three sentinel conditions. For example, emergency and trauma care systems across the country might be tasked with providing data on such conditions as cardiac arrest (see Box 3-1), pediatric respiratory arrest, and major blunt trauma with shock. Data from the different system components would allow researchers to measure how well the system performs at each level of care (9-1-1, first response, EMS, and ED).

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