EMS Reason for Encounter(RFE)

Greg Mears, MD FACEPPrincipal Investigator

North Carolina EMS Medical DirectorUniversity of North Carolina-Chapel Hill

RFE?

What is it? When did this idea happen? Where did the idea come from? Why do we need it? How do we get it?

What is it?

Coding system for EMS Uniform description of the reason for an

EMS encounter Not diagnostic (not mapped to ICD-9) Based on EMS curriculum skill set Based on NHTSA dataset Reproducible A calculation, not a code

Reason for Encounter

Two year project Funded by NHTSA

Where did the idea come from?

Problems Quality Management

Patient Care EMS System EMS Technician

EMS Outcomes EMS Research Surveillance Reimbursement

Example of Problem

Respiratory Distress could be: Asthma COPD Pneumonia Trauma-Chest wall contusion or

pneumothx Foreign Body Congestive Heart Failure

Why do we need it?

Same issues Quality

Management Outcomes Research Surveillance Reimbursement

Also System Design Information Systems

Merging several systems data together

National EMS Database Descriptive Information

Linkage or pass through to other healthcare information systems

EMS Policy and Funding

Final RFE

DefinitionPurposeMethodDatapointsEvaluation

RFE Definition

An EMS reason for encounter is an objective description of the patient’s problem which forms the basis of EMS care, based on the compilation and/or calculation of existing EMS patient care report documentation.

Purpose

The RFE serves to subdivide EMS patients into defined groups which are reproducible, independent, and usable for EMS quality management.

Method

Dual Evaluation by pilot data to develop a final RFE Cluster analysis based on all datapoints within

either the NHTSA or PreMIS datasets.• Did not reveal a valid method for RFE

Treed description based on • Injury• Complaint• Location• System• Acuity• Accepted method by the Task Force

Parameters

Must include all technician levels? Must be derived from the NHTSA dataset?

• The datapoints will become a component of the NHTSA dataset version 2.0

Must conform to the EMS curriculum?• The EMS curriculum addresses each of the

datapoints at all personnel levels. • The organ system data point was felt to only be valid

for EMT-Paramedic level personnel Must not require coding?

• Coding is not required, only completion of the datapoints as part of normal documentation

Analysis

Evaluate the models by validating the RFE with: Provider coding of RFE Hospital diagnosis

• Mapping RFE to Hospital Diagnosis failed. • Decision: RFE must stand alone but be reproducible in the

EMS community

Analysis for accuracy and reproducibility Review of 500 NC PreMIS records which document RFE

components Multiple RFE’s per patient

• To complicated for the initial project.• A single RFE per patient was determined to be the goal.

RFE Data Points

Injury Present Primary Complaint Anatomic

Location Primary Symptom Primary Complaint Organ System

Injury Present

Yes No Unknown

• Indication whether or not there was an injury.

Primary Complaint Anatomic Location

Abdomen Back Chest Extremity-Lower Extremity-Upper General/Global Genitalia Head Neck

• The anatomic location of the chief (primary) complaint as identified by EMS personnel

Primary Symptom

Bleeding Breathing Problem Change in Responsiveness Choking Death Device/Equipment Problem Diarrhea Drainage/Discharge Fever Malaise Mass/Lesion Mental/Psych Nausea/Vomiting

None Pain Palpitations Rash/Itching Swelling Transport Only Weakness Wound

• The primary symptom present in the patient or observed by EMS personnel

Primary Complaint Organ System

Cardiovascular Central Nervous

System Endocrine/Metabolic Gastro-intestinal Global/General Musculoskeletal Obstetrics/Gynecology Psychological Pulmonary Renal Skin

• The organ system of the patient chief (primary) complaint which is injured or affected, based on the evaluation of an EMT-Paramedic.

Verification

Large scale reliability of all EMS RFEs. All technician levels Rural vs. Urban Volunteer vs. Paid Other states, geography

• No able to be completed within time frame and funding level

Evaluation

500 Records were evaluated by the PI for the following: Completion of the Datapoints based on

the review of the Ambulance Care Report Documentation of the EMT personnel

level completing the form Identification of a Volunteer or Paid EMS

Service Population of the Service Area

Evaluation Results

Injury Present

Anatomic Location

Primary Symptom

EMT-B 95/96 (99%)

92/96 (96%)

88/96 (92%)

EMT-D 100/104 (96%)

98/104 (94%)

95/104 (91%)

EMT-I 99/100 (99%)

96/100 (96%)

92/100 (92%)

EMT-P 198/200 (99%)

195/200 (98%)

190/200 (95%)

EMS Reason for Encounter(RFE)