Results of a Quality Improvement Initiative to Increase the Completion Rate of Electronic Health Records for Patient Encounters at a Large Urban Fire-Based Non-Transporting EMS Agency

Abstract

Introduction

Documentation of patient care is essential for both out-of-hospital and in-hospital clinical management. Secondarily, documentation is key for monitoring and improving quality; however, in some EMS systems initial care is often provided by non-transporting agencies whose personnel may not routinely complete patient care reports. Limited data exist describing effective methods for increasing complete patient care documentation among non-transporting agencies. The aim of this quality improvement project was to increase electronic health record (EHR) documentation compliance in a large urban fire-based non-transporting EMS agency.

Methods

The improvement project began in May 2020. Our primary outcome was the proportion of completed EHR records for EMS responses. Primary drivers were determined from informal interviews with front-line firefighters. Interventions were implemented following a Plan-Do-Study-Act (PDSA) approach first at a single station, then battalion, and ultimately at the entire department. Interventions included performance reports, modifications of chart requirements, localized directive requiring EHR completion for all EMS runs, directive to officers that EHRs are required, documentation training, and a department-wide directive. We used statistical process control charts (p-chart) to identify special cause variation following interventions.

Results

The baseline of EHR completion for the entire fire department was 5% (373/7423 records) for the month of January 2020. Front-line interviews with 58 firefighters revealed drivers including lack of accountability and unfamiliarity with the software. After implementing a station performance report at one fire station, the station’s EHR rate climbed from 0.9% (3/337 records) to 26.7% (179/671) after 9 weeks. This test was expanded to a battalion of six stations with similar results. After multiple PDSA cycles focused on agency policy and training, overall department wide EHR compliance per month improved to 89% (4,816/5,439 records) for the month of February 2021 and sustained in following months.

Conclusions

Within this large urban fire department, EHR documentation compliance improved significantly through a series of tests of change. Informal interviews with front-line personnel were instrumental in determining primary drivers to develop change ideas. Performance reports, training and facilitation of the reporting process, and department-wide directives led to acceptance and improvement with EHR compliance.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This quality improvement initiative was not grant funded.