2025; 8(2): 1-11
DOI: 10.32114/CCI.2025.8.2.1.11
Published online: 2025-06-30 (first online 2025-03-24)
Mislabeled out-of-hospital patient care records during transitions of care: a quality improvement intervention using root cause analysis (RCA) in an EMS system.
Luis Mauricio Pinet-Peralta [1]
,
Nicole Y. Duppins [2] .
[1] University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, United States.
[2] Prince George’s County Fire/EMS, McCormick Drive, Largo Maryland, United States.
Abstract:
Abstract [EN] -
INTRODUCTION: Out-of-hospital emergency care has developed dramatically and grown more complex in the last decade. Transfer of care between out-of-hospital clinicians and the emergency department (ED) staff drives the connection to the healthcare system. Across the US, this process is highly variable and not standardized, which may lead to adverse events. The purpose of this quality study is to identify the cause of mislabeled EMS patient care reports in an EMS agency and develop an intervention to reduce the rate of mislabeled patient care reports. MATERIALS AND METHODS: This quality improvement study follows the model for improvement process, using PDCA cycles and root cause analysis, and used the two-sample unmatched Wilcoxon rank-sum to test for differences in the number of mislabeled records after intervention implementation. RESULTS: Before the intervention, the receiving facilities identified a total of 75 mislabeled ePCR. After implementation of the facility code changes, the receiving facilities identified a reduction in the number of mislabeled ePCRs received from Agency E, from 37 in January to 14 in April. This change represents a 37.83% (z=-10.583, p=0.000) reduction in the number of mislabeled ePCRs, although the EMS Agency E still accounts for the largest proportion of mislabeled records with more than 70%, even after the intervention. CONCLUSIONS: A considerable number of mislabeled records (65%) remain unexplained by the technological factors identified in the PDCA Root Cause Analysis approach. Other factors, including human factors and other technological factors not addressed in this study, which may require validation rules, may still be contributing to mislabeled EMS records.
Streszczenie [PL] -
WSTĘP: Opieka doraźna poza szpitalem rozwinęła się dynamicznie i stała się bardziej złożona w ciągu ostatniej dekady. Przekazywanie opieki na pacjentem między lekarzami poza szpitalem a personelem oddziału ratunkowego (ED) wymaga połączenia systemów opieki zdrowotnej. W całych Stanach Zjednoczonych proces ten jest bardzo zmienny i nieustandaryzowany, co może prowadzić do zdarzeń niepożądanych. Celem tego badania jest zidentyfikowanie przyczyny błędnie oznaczonych raportów opieki nad pacjentami pogotowia ratunkowego (EMS) i opracowanie interwencji w celu zmniejszenia liczby błędnie oznaczonych raportów opieki nad pacjentami. MATERIAŁY I METODY: To badanie poprawy jakości podąża za modelem procesu doskonalenia, wykorzystując cykle PDCA i analizę przyczyn źródłowych, wykorzystano dwupróbkową sumę rang Wilcoxona do przetestowania różnic w liczbie błędnie oznaczonych rekordów po wdrożeniu interwencji. WYNIKI: Przed interwencją placówki odbiorcze zidentyfikowały łącznie 75 błędnie oznaczonych ePCR. Po wprowadzeniu zmian w kodach placówek, placówki odbiorcze odnotowały zmniejszenie liczby błędnie oznakowanych ePCR otrzymanych od Agencji, z 37 w styczniu do 14 w kwietniu. Zmiana ta oznacza zmniejszenie liczby błędnie oznakowanych ePCR o 37,83% (z=-10,583, p=0,000), chociaż Agencja EMS nadal odpowiada za największą część błędnie oznakowanych rekordów, przekraczającą 70%, nawet po interwencji. WNIOSKI: Znaczna liczba błędnie oznakowanych rekordów (65%) pozostaje niewyjaśniona przez czynniki technologiczne zidentyfikowane w podejściu PDCA. Inne czynniki, w tym czynniki ludzkie i inne czynniki technologiczne nieuwzględnione w tym badaniu, które mogą wymagać reguł walidacji, mogą nadal przyczyniać się do błędnie oznakowanych rekordów EMS.
Citation:
VANCOUVER FORMAT
Pinet-Peralta LM, Duppins NY. Mislabeled out-of-hospital patient care records during transitions of care: a quality improvement intervention using root cause analysis (RCA) in an EMS system.
Crit. Care Innov. 2025; 8(2): 1-11.
DOI: 10.32114/CCI.2025.8.2.1.11
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