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Quality Corner

May 2016

The Disposition

This month we focus on the disposition (for your VPHIB folks out there, this is the element “Destination Patient Disposition”).   For example, you’re working on an ambulance today and you transport a patient to the hospital.  For that patient care report, you’d mark the disposition as “Treated, Transported by EMS”.   If you obtained a refusal on a patient, your disposition for the call would be “Patient Refused Care”.    But what happens if more than one unit responds to the same call?  This is where things get dicey…

The ODEMSA Performance Improvement Committee (PIC) looked at dispositions by Agency Primary Role of Unit (i.e. a transport unit, a first responder unit, a supervisor car, etc.) for July-Sept 2015.  For the nearly 63,000 run reports in the ODEMSA region for that quarter, over 10% (6,400) of the run reports were by a non-transport unit and had a disposition of “Treated, Transported by EMS”. Not only is this a data quality issue, but several of our other studies were artificially inflated when we look at patients that were transported to the hospital.

To illustrate, consider the following scenario.   You’re volunteering (or working) on a fire engine and you’re punched out to first respond to a patient with difficulty breathing.   An ambulance is also dispatched.  You arrive, make patient contact, and start treating the patient.  The ambulance crew arrives and continues your care.   You assist in packaging the patient and loading them into the ambulance.  The ambulance transports the patient to the local hospital.  As you finish your ePPCR, you get to disposition.  What do you put?   The correct disposition for this situation for the crew on the fire engine is “Treated, Transferred Care”.

The confusion might be in the term “Treated, Transported by EMS”.  It seems perfectly reasonable look at your options and select this outcome.  After all, your patient WAS transported by EMS.  But remember the disposition is not some much for the patient, but for your apparatus/unit. This also applies to transport units as well---did you transfer your patient to a higher level of care?  Did you transfer your patient to a helicopter crew?  The disposition “Treated, Transferred Care” is the appropriate choice for these situations.

Unless the patient was transported in your ambulance, the disposition should not be Treated, Transported by EMS.  If you transferred care, don’t forget to fill out the appropriate fields in you ePPCR software indicating which agency your transferred to (even if it is your same agency), and the time of the transfer.  It is a good idea to also get a signature from the person assuming care, but follow your agency’s internal policy for this.

Thank you for taking the time to improve your data quality.  Your data will not only be used to assess the status of our regional and state systems, but will also be used on a national level for studies and policy recommendations. Good data in, good data out.

More information on dispositions can be found in the VPHIB Data Dictionary Version 3 (page 249) available on the VPHIB support website.