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Clinical Performance Standards

Purpose

Clinical Performance Metrics are designed to monitor and benchmark evidence-based measures that have been demonstrated to promote optimal outcomes for certain types of patients. The District, through its Board of Commissioners, and in consultation with its Medical Director, have designed three levels of performance metrics to be reported on an ongoing basis.

  • Never Events
  • Percentage Clinical Performance Standards (PCPS)
  • Other Monitored Clinical Metrics

Never Events

Table 1 below identifies specific, objective, and readily-identifiable adverse or sentinel events that the District has determined should never occur in Provider’s performance of services under the Agreement. Accordingly, upon occurrence of any of these events, and upon completion of the collaborative review process, to discuss the root cause and action plan to mitigate future individual or system related occurrences, including but not limited to, individual or group training. 

Industry data suggest that these events should indeed be infrequent and the District accordingly does not anticipate that Never Events will result in termination. Furthermore, the District understands and agrees that each transport/ patient encounter may involve its own unique circumstances, including but not limited to severity, presentation, environment, patient choice and patient stability and therefore each event will be reviewed based on its unique circumstance/ interaction.

Occurrence of a Never Event is Reportable Within 48 Hours to the District.
 

CATEGORY 1: CARDIORESPIRATORY NEVER EVENTS

  • Failure to transport a suspected STEMI patient to a designated STEMI center.
  • Unrecognized endotracheal tube placement in esophagus resulting in death or serious adverse consequence.
  • Failure to monitor ETCO2 after advanced airway placement.

CATEGORY 2: STROKE/NEURO NEVER EVENTS

  • Failure to transport a Stroke Alert patient to a designated primary or comprehensive stroke center.

CATEGORY 3: TRAUMA NEVER HIGH RISK EVENTS

  • Failure to transport (by ground or air) a Critical Trauma Patient (as defined in most current CATRAC policies) to a designated trauma center, excluding traumatic or pending traumatic arrest.

CATEGORY 4: OTHER NEVER EVENTS

  • Death or serious adverse consequence associated with administration of incorrect medication or dosage.
  • Patient death or serious adverse consequence associated with improper use or failure of a medical device or equipment including a vehicle related mission failure (i.e. an inability to complete the call).
  • Patient death or serious adverse consequence associated with untreated known hypoglycemia during interval of EMS care.
  • Failure to report a Never Event within 48 hours in the manner required by BCESD3 EMS policy.

 

Clinical Performance Standards (CPS)

Acadian will be responsible to achieve the following Clinical Performance Standards throughout the term of the Agreement. The District expanded performance measurement beyond traditional response times to include evidence-based measures that promote optimal patient outcomes and should result in a high-quality service delivery model.

The performance metrics will be reviewed on a quarterly basis. 

The relevant American Heart Association or National EMS Quality Alliance measure is referenced where applicable. Should a reference measure definition be changed or deprecated, the new definition shall be adopted.  The District understands and agrees that each transport/ patient encounter may involve its own unique circumstances, including but not limited to severity, presentation, environment, patient choice and patient stability and therefore each event and scene time measurement will be reviewed based on its unique circumstance/ interaction.

CLINICAL PERFORMANCE STANDARD MEASURES (QUARTERLY)

CATEGORY 1: CARDIOVASCULAR MEASURES

  • EKG for Emergency Patients with a cardiac complaint - Percentage of Emergency Patients with Primary Impression of Chest Pain, angina, palpitations, arrhythmias or syncope getting a 12-lead EKG. (AHAEMS5)
  • EKG for Emergency Patients with an impression requiring a 12-Lead - Percentage of Emergency Patients with a primary impression that requires a 12-lead per the medical director’s protocols (i.e. abdominal pain, weakness, etc.).  (AHAEMS5 expanded to include other impressions requiring a 12-Lead per the Provider’s protocols)
  • Pre-arrival notification for STEMI-positive Emergency Patients - Percentage of Emergency Patients with a pre-arrival notification less than or equal to 10 minutes of a STEMI-positive 12-Lead
  • Aspirin Administration for STEMI -Percentage of Emergency Patients with suspected STEMI who receive ASA during prehospital treatment. (AHAEMS6)
  • Total On-Scene Time for STEMI patients - Percentage of STEMI Emergency Patients with on-scene times of < 15 minutes (excluding patients transported by air)

CATEGORY 2: STROKE/NEURO MEASURES

  • Blood Glucose Assessment for Stroke Emergency Patients - Percentage of primary impression Stroke/TIA or Stroke Alert with documentation on the PCR of blood glucose reading. (AHAEMS3)
  • TLKW Documentation for Stroke patients - Percentage of Stroke Alert patients with documentation on the PCR of the Time Last Known Well. (AHAEMS2)
  • Pre-arrival notification of Stroke Alert - Percentage of primary impression Stroke/TIA or Stroke Alert with documentation of a prehospital stroke notification prior to hospital arrival. (add 10 minutes of a positive stroke exam) (AHAEMS1)
  • Total on-Scene Time for Stroke Alert Emergency Patients - Percentage of Stroke Alert patients with on-scene time < 15 minutes (excluding Emergency Patients transported by air or advanced airway management).
  • Altered Mental Status Receiving a Documented and Complete Stroke Assessment - Percentage of Emergency Patients with a sudden, unexplained neurological deficit* with a documented stroke exam.  (*AHAEMS4 modified to include Emergency Patients with a primary impression of stroke, TIA, AMS, weakness, syncope, dizziness)

CATEGORY 3: TRAUMA MEASURES

  • Trauma Activation Notification - Percentage of EMS transports originating from a 911 request for Emergency Patients meeting Step 1 or Step 2 prehospital field triage criteria for trauma during which a pre-arrival trauma alert is initiated.  (Trauma-14)

 

Targets. Although reporting is expected monthly for review purposes, incentives will be assessed on a quarterly basis for the preceding three months of activity. This should allow sufficient volume to draw reasonable conclusions on the compliance for each measure.

 

TargetIncentive Threshold
June 2025 - Sept. 2025WaivedWaived
October 2025 and beyond90%95%

Other Monitored Clinical Metrics

In addition to the Clinical Performance Standards above, the Provider shall provide the District with monthly trended performance reporting of the current version of the National EMS Quality Alliance measures. These measures have been developed by the NEMSQA Development Committee and approved by the NEMSQA Board of Trustees. Together, the Provider and the District will review performance monthly to identify and prioritize areas for potential system improvement.

 

American Heart Association Mission LIfeline Measures

National EMS Quality Alliance Measures

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