Generally, the public associates ambulances and sirens with action, not data collection and analytics. However, BC Emergency Health Services (BCEHS) gathers extensive data in the care of their patients. The data collected on the patient’s journey – from the medical emergency event to transporting the patient to hospital – provides key information about the care they received and where improvements can be made.
According to the BC Trauma Registry, roughly 180,000 patients with traumatic injuries are cared for and transported by paramedics each year; how do you review quality of care for each of them?
To measure quality of care, it’s vital that patient information is collected cleanly and organized for results. “Looking at silos of data can be difficult when your goal is to get a bird’s eye view of what happened to the patient,” says Jaimini Thakore, lead, Data, Evaluation and Analytics with Trauma Services BC (TSBC). “What we had to do was take all the information from the paramedics and create one patient-centric view.”
“It is well established that severely injured patients have better outcomes when treated at trauma centres.” says Wilson Wan, interim chief medical officer, BCEHS. “Linking data between BCEHS and TSBC helps us better understand how paramedics recognize severely injured patients, and the impact to each individual trauma patient based on where they are transported.”
“When you’re in my field, in analytics, the numbers and statistics can make you feel detached from the actual patient and what they’re experiencing,” says Recep Gezer, trauma biostatistician at TSBC. “This project gives an interesting lens to see what’s going on with each patient and how you can change the system to help the next patient have better care.”
TSBC and BCEHS partnered to update the way BCEHS organizes its data related to traumatic injuries. They shared data collected during a patient’s journey after a major trauma into a single record using a set of algorithms. The resulting dataset simplified a series of complex data points so that decision makers could develop performance metrics. This project used analytics to identify high risk cases for review by paramedic practice leads and health authority trauma leads to improve patient care.
Niyati Makkar, a business intelligence specialist with TSBC, was the developer on the project and responsible for building this new patient-centric view of the data. She used data generated from BCEHS dispatch and patient care record systems to link to Trauma Registry records, which are as follows:
- The file with the most information, called the events table, conveyed data about the incident including when the call was received by BCEHS 9-1-1 call takers, the location, how many ambulances were dispatched and which arrived first.
- The response table – when and how many ambulances were dispatched for a particular incident, which arrived first, and which ambulance transported the patient to the appropriate care facility.
- The patient table, aptly named, holds data about the patient such as Personal Health Number, age, date of birth, vitals taken on scene.
- The management table – details the treatment given to the patient at the event.
“9-1-1 data, BCEHS electronic patient record (SIREN) and Trauma Registry data was stored in separate databases,” says Gezer. “In order to trace the patient’s journey from the time of incident all the way to, for example, Vancouver General Hospital, we connected those databases together.”
“The BCEHS team has also streamlined processes for clinical case review and feedback to paramedics for ongoing professional development and learning,” adds Wan.
The BCEHS electronic database needs to support patient care documentation as well as resources used to optimize triage and transport. Sometimes there are multiple ambulances sent to an incident with multiple injured patients. When paramedics are responding to a medical emergency, the first responders may document part of the information – for example, vital signs – and hand off documentation to a second crew who may deliver more advanced care, then transport the patient to hospital. Detailed times and measurements are recorded but may be in separate places in the BCEHS database.
“We’re improving the quality of data analysis and making it less labour-intensive because now we’re able to look at large volumes of data,” says Thakore. “On average, ambulances transport approximately 180,000 patients per year with traumatic injuries. How do you review quality of care on so many patients?”
“With this linkage between BCEHS and Trauma Registry data, BCEHS is now able to obtain information about what happened to a major trauma patient after arriving at the hospital, and the hospital obtains information about what happened to a major trauma patient prior to arrivals,” says Gezer. “The combined information helps us improve patient care.”