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)