Could Busier be Better?

There is plenty of talk about “evidence-based procedures” in EMS lately. Well, today I read an interesting article that shows a link between being busier and better patient outcomes.

Okay…, now after reading that statement, what just happened to your heart rate? Was your automatic response to click the link in order find fault so you can dismiss the finding, or did it pique a genuine interest to read the article and find what might be of value to you personally in hopes of possibly achieving a better understanding of even one aspect in a very complex patient/care giver dynamic? It is interesting to see how we respond to “evidence” we don’t necessarily like, or evidence that contradicts with our own longstanding personal stereotypes.  I know that whenever I talk about Dynamic Deployment, or System Status Management, I immediately hear complaints from those who work in the field that it is all about the numbers and is often driven by greedy consultants forcing “snake oil” math on all too willing administrators who have forgotten their “street experience.” I usually try to combat the stereotype perception with facts about more progressive experiences with creating high performance systems, but I will admit right here that everyone is at least partially right – it really is about the numbers. However, it may not just be the same numbers you are thinking (but I will stick to my assertion that the logic is probably much less nefarious than suspected.)

Time is an easy thing to measure, but in itself, it is seldom very important. In fact, it can be much like a single vital statistic from a patient taken out of context. Still, time is a pretty fair proxy measure of performance on the aggregate.  And, like good base line vitals, it becomes especially useful when combined with other numbers.  Now, before writing your comment, please note that I never said anything about a 7:59 response standard, I was only talking about measuring time in the abstract.  I believe the argument over response time standards is very similar to arguing that everyone should have a BP of 120/80. Sometimes it is the right goal, but for others, or depending on the situation, the target may be higher or lower.

Each of us measures our work shift in terms of hours.  System Status Management extends that basic idea by measuring everyone’s time in a shift along with the work they accomplish and balance it against the public’s perception, reasonable risk, and the actual needs of individual patients and their providers.  There are plenty of bad examples out there and I refuse to justify them, but at the same time there are good examples of systems that are improving and taking the right measures into account.

The key is not UHU, TOT, response times, compliance, ROSC, patient outcomes, employee satisfaction or budgets – it is all of those things and much more. Those numbers are no more definitive in themselves than BP, pulse, O2 sats, capnography, skin condition, ECG, GCS or anything else we measure is a truly accurate indication of a person’s overall health. Similarly, it is no less fair to view SSM as a static group of measures than to believe the components of our patient assessment are unchanging. If some medic had overly emphasized, or even ignored, some measures in an assessment, that specific experience should not condemn a process that has been proven valuable in many other cases.

It may seem that I have ventured pretty far from the question with which I started this post about how busy we should be in order to be most effective. You may have even thought I was promoting an idea to maximize every minute.  As for the clinical interpretation of the answer, I will leave that to the authors of the particular study I referenced.  Instead, I will suggest that we all must be a little busier in understanding how our collective time and actions impact the performance of the systems in which we work. It doesn’t matter if your service is private, non-profit, fire-based or whatever; money and resources are always finite while demand and expectations are often increasing.  I would ask that you don’t simply rely on the assessment from “vitals” of SSM taken years ago, but reassess with an open mind and set aside the prejudices of previous assessments. After all, very little in our business is truly static. Like a “routine” interfacility transport, we can assume nothing has changed regarding the patient’s condition, or we can get busy and engage in our profession looking to have a positive impact on potential outcomes. Don’t leave leadership to the administrators, but take initiative to at least understand, if not improve, your corporate mission. You may be caring for patients, but the care of your career is part of your job too. Get even busier and improve that outcome for yourself.

9 Comments

  • GCaine says:

    I really did not see a definitive answer to the question you posed, nor any concrete evidence to support the answer that was not really given. This seemed more like rhetorical question on which you shined a small beam of informational light to support your own opinions. Here is a simple fact regarding EMS as a whole, we are severly over worked, under appreciated, and drastically under paid, while at the same time the skill set, scope of practice, and knowledge requirements are steadily increasing with out any compensation or improvement of work quality. That is just my 2 cents.

  • Medics are heroes , they go to bad places and areas , with good and bad people , they work 24/ 7 . and companies they don’t want to pay what they deserve . But they save your lives , or they see when they don’t make it .

  • Marc says:

    Wow! Such insight. What a truly marvelous example of…rambling. The question about being busy and its relation to quality wasn’t answered and had absolutely nothing to do with everything you wrote after the title. The best I can conclude is some manager somewhere held a gun to your head and made you write a piece that pleads for us to think about SSM the same way I think about my happy place. If you’ll excuse me, I’m going there now.

  • Steven Rausch says:

    Did anyone read the cited article? It is about emergency departments, not EMS systems. Two different issues.

  • Kevin Lloyd says:

    Busier in my book equals EMS burn out in high gear!!

  • Greg says:

    While I didn’t see a definitive answer myself, I can provide some insight. I began working for Richmond Ambulance Authority almost two months ago. This is a high performance system using SSM. I was apprehensive at first about spending 12 hours a day in the truck, bouncing between calls and sitting on street corners. But with the call volume this city see’s on a given day, responding to every call from the current station would put most patients a risk and greatly delay adequate care. Also, there simply isn’t the real estate to build additional stations in all the key areas, not is there room for all of our trucks and personnel in the fire houses. While I haven’t been here long enough to provide an adequate opinion, it seems to me that call volume has little to do with burn out. If you learn to live on the salary you’re given, and it’s possible because millions of providers do it every day, don’t constantly sign up for OT shifts, and spend time with family and friends doing things you enjoy outside of the work environment, it won’t matter if you run two calls a day or twelve. But that’s just me!

  • Paul says:

    High quality comes from seeing multiples of truley sick patients with strong training and support from an experienced partner, not just from being a busy transport vehicle.

  • Lauren says:

    This article is more about understanding evidence based research then applying it rather then replying on personal experience and tradition. Even if you don’t like what research says.

  • Alex says:

    Since medical calls are now the focus of fire service. Maybe it’s time for a rebranding if you will to new terms like “EMS Based Fire Service”. Paramedics are constantly upgrading thier knowledge and skills and get thier butts kicked daily but don’t enjoy the same pay or benifits that firefighters do. Something is wrong here.

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