LifeFlight Eagle's Outreach QA process is improving speed and patient outcomes

LifeFlight Eagle has always had an internal Quality Assurance program, but in 2010, the organization embarked on an initiative to improve its already high standards of patient care by more actively engaging its partners at EMS agencies and hospitals. The goal of its Outreach Quality Assurance program is to use clinical data and evidence-based medicine to improve processes and ensure better patient outcomes.

"We feel like we've always done an excellent job taking care of our patients, but we want to raise the bar and get even better," said Stacey Dock, LifeFlight Eagle's Clinical Services Manager. "We want to identify areas that we can improve even the little things that can help make a difference for our patients."

E2 LoadOsawatomie 600pxAt LifeFlight Eagle, that process begins with a review of every single patient chart by highly experienced nurses who serve as QA coordinators. They identify areas that have opportunities for improvement. They track performance and benchmark it to specific goals.

By analyzing the data from these chart reviews, Dock and the QA coordinators are able to identify trends, design education to help improve performance, and revise clinical protocols.

One of the early successes of LifeFlight Eagle's Outreach QA program was improving bedside times. LifeFlight Eagle carefully measures the time between when its flight paramedic and flight nurse arrive at a patient's side in a hospital or at a scene, until they take off with the patient onboard the helicopter.

For patients with time-critical diagnoses, including strokes, heart attacks and traumatic injuries, every minute counts. The sooner the patient reaches definitive care at a large hospital, the better chance they have of making a full recovery.

"We drilled down and analyzed everything we could. We even scripted internally how to completely prepare the patient for transport and keep it as efficient as possible," said Dock. "If the bedside time was too long, then we documented why, so we could know what slowed us down and develop ways to combat those obstacles.

Then they began engaging their partners at EMS agencies and hospitals in the QA process. They coordinated with leaders at those agencies, shared their goals, and collaborated on ways that they could work better together to improve patient outcomes.

Miami County EMS in Kansas was one of LifeFlight Eagle's first QA partners.

By discussing and working together, the organizations were able to streamline the process of preparing critically injured and ill patients for transport on the helicopter. Through that coordination, Miami County EMS personnel now do most prep work before the helicopter even arrives on scene.

"Depending on the situation of the patient, we make sure we have one IV, if not two started," said Miami County EMS Deputy Chief Frank Burrow. "If the patient needs to be intubated or a 12-lead EKG attached, we do it. If we can do everything we can to minimize ground time, it's much better for the patient to get to the destination sooner."
As a result of the coordination, LifeFlight Eagle's scene time has decreased by an average of 7 minutes per flight in Miami County. That enormous time savings can make a difference in whether a patient survives, or how well he or she recovers.

LifeFlight Eagle has gone through a similar process with several community hospitals, working with them to understand what needs to be completed prior to an inter-facility flight. Sometimes the small things can make a big difference, such as knowing what paperwork is necessary and having the patient as prepared as possible. By ensuring that hospitals know how to help LifeFlight Eagle be more efficient, average bedside times have dropped by six minutes at some facilities.

The QA process extends beyond speed, though. During quarterly QA meetings with its partners, LifeFlight Eagle and the hospital or EMS agency also review each patient's chart together, discuss patient care and share best practices.

Dock said she hopes to expand this QA process to all hospitals and EMS agencies in LifeFlight Eagle's service area.

"It's not about finding fault with anyone," said Dock. "It's about better coordination and collaborative patient care. We talk about 'What could have gone smoother? How could we have communicated with each other better? How do we improve upon our processes?' We want to become an even better team and be more cohesive with the care we provide our patients. We always want our patients to have the best possible outcomes and we will always look for ways to improve."