Defining core data for continuous benchmarking in pre-hospital critical care

Abstract

The aim of medical research is to improve patient care through evidence-based practice. Currently, the evidence base in physician-staffed emergency medical services (p-EMS) is weak and we remain uncertain for which patients p-EMS assistance is essential to and for which patients p-EMS is not needed. To increase the evidence-base of p-EMS and to evaluate its potential effects, high quality data is pivotal. Currently, data is not reported uniformly, thereby complicating research. Furthermore, we should make better use of routinely collected data as these are readily available, thereby facilitating research. The aim of this thesis was to increase the quality of routinely reported data in p-EMS by focusing on accuracy and completeness. We did this through the following objectives: 1. Explore the feasibility of collecting template data according to a predefined template 2. Explore whether pre-hospital physicians can score a reliable pre-event American Society of Anesthesiologists Physical Scale (ASA-PS) on-scene 3. Describe the quality of reported Glasgow Coma Score (GCS) and Systolic Blood Pressure (SBP) data in studies depicting p-EMS 4. Revise and update a template for reporting in p-EMS We conducted four studies; one feasibility study, one prospective observational study, one systematic literature review and one qualitative consensus project. Accuracy and completeness are two important attributes describing quality in medical research. Without accurate data, research will be inaccurate and erroneous conclusions can be drawn. Furthermore, high completeness rates are always preferable to incomplete data. Based on the four studies we can conclude that the use of a template is feasible in p-EMS, that the quality of reported GCS and SBP is variable and that a reliable pre-event ASA-PS can be scored on-scene. We also created an updated template for reporting in p-EMS. The findings are important because highlighting the varying quality of reporting in p-EMS may increase awareness which may further increase both accuracy and completeness. Furthermore, we argue for incorporation of a full pre-event ASA-PS when reporting from p-EMS, thereby enabling us to take comorbidity into account in p-EMS research. By reporting according to the updated template, we may, in the future, enable comparisons and further development of p-EMS.