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Interdisciplinary Medical Teams and the Challenges They Face

We have all seen, heard and breathed the saying that it takes teamwork to succeed. However, how that belief translates into day-to-day operations differs between organizations. Fire and EMS agencies that will succeed in the future will be dependent on the interdisciplinary teams they form and support.

What is an interdisciplinary team? An interdisciplinary team is defined as a team formulated by members of different disciplines or specialties. In 2006, we formed our first team with Castle Rock (Colo.) Fire Rescue. The team that we have formed is made up of:

  • EMS chiefs
  • EMS medical directors and staff (hospital staff)
  • Line personnel at all ranks
  • Training personnel
  • Ad hoc subject-matter experts (quality, finance, etc.)

Shortly after our formation, Fire Chief Art Morales challenged us to build a performance-improvement program that could show all stakeholders the department's performance. Due to the diversity and dedication of the team, within one year we were able to report on quality metrics that exceeded national standards. It has since expanded throughout the Denver Metropolitan area as a best practice.

After you have formed your team (or if you have one in place now), there are three main areas the team should pay particular attention to:

  • Are the EMS protocols we are developing based on established best practices supported by medical literature?
  • Are we following the protocols?
  • Are our customers satisfied with our care?

To solve these complex problems and answer these questions, and more importantly, to be able to answer to stakeholders, fire and EMS agencies must have an established interdisciplinary group working on them.

In The Wisdom of Crowds, James Surowiecki describes a story regarding the USS Scorpion. The USS Scorpion was a nuclear submarine commissioned in 1960 and primarily operated in Europe and along the Eastern cost of the United States.

In February 1968, the submarine left Norfolk Naval Shipyard for a deployment in the Mediterranean. On May 21, the Scorpion updated Norfolk on their position; five days later, the Scorpion was overdue and did not check in. A search was immediately initiated, searching hundreds of miles of sea, but to no avail.

An officer decided to gather a team of experts from various fields, including mathematics, submarines and salvage; statistical analysis was used based on the expert's guesses to form a consensus. The individual guesses were nowhere close to accurate. However, the average of the consensus guess was 300 yards from the actual submarine wreckage. The power of the many versus individuals is clear, especially in solving complex problems.

Healthcare has seen for several years now and will continue to see many tough challenges ahead. Increased regulatory requirements coupled with decreasing reimbursement rates make the environment difficult to navigate, let alone succeed in. There have been three recent changes in healthcare that require attention from our colleagues in EMS.

The first is national recommendations for what quality metrics we should be monitoring. In 2008, the U.S. Municipal Metropolitan EMS Medical Directors provided a model of national benchmarks for EMS agencies to measure. "Evidence-Based Performance Measures for Emergency Medical Services Systems: A Model for Expanded EMS Benchmarking," in Prehospital Emergency Care (12:2, pgs 141—151), outlined all the clinical areas we should be monitoring and thus may be compared to. Some of these recommendations include:

  • 12-lead EKG times and aspirin administration for those having an acute myocardial infarction
  • Use of continued positive pressure ventilation in heart failure
  • Use of beta agonists in asthma
  • Control of seizures
  • On-scene times of trauma

Second, a clear and direct focus on reimbursement based on performance will occur in the near future. In May 2005, Mark McClellan, past administrator for the Center for Medicare and Medicaid (CMS), made it very clear in testimony before the House Committee on Energy and Commerce (PDF). CMS believes that an important component of delivering high-quality healthcare is the ability to measure and evaluate quality. Accordingly, CMS is committed to the development of payment systems that will support and reward quality.

This type off structure is already being implemented in hospitals as well as other healthcare entities; it's only a matter of time before it reaches EMS.

Third, not only will clinical quality be in focus, but how well we provide customer service will also be monitored. In 2008, CMS launched the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (PDF). It is the first national, standardized, publicly reported survey of patients' perspectives of hospital care. Cleanliness of the room, how doctors and nurses communicate and pain control are some of the data points collected from the patient and publicly reported.

EMS agency leaders must ask themselves, how would we report our customer satisfaction publicly? The future of reimbursement for healthcare will not just be based on what we do, but how we do it.

Last year, Michael Lewis's book Boomerang: Travels in the New Third World (what we would describe as required reading for any fire/EMS chief) described the environment that we're all in, one in which the financial pressures are extreme and our action—or inaction—will have repercussions.

It's now more important than ever to prove to stakeholders what great care we provide.

Garrett Chism, EMT-P, MBA, is the EMS, trauma and disaster preparedness manager for Sky Ridge Medical Center in Lone Tree, Colorado. Dr. Steve Heinz, MD, is the chair of the Emergency Department and EMS Medical Director for Sky Ridge Medical Center.

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