Assessment of ambulance interventions; proposal of a performance measurement framework for healthcare improvement in EMS response to patient collapse
Abstract Background Healthcare improvement at all levels involves systematic and continuous assessment of the system’s operations, efficiency, and effectiveness to ensure quality care. Likewise, in Emergency Medical Services; performance measurement and root cause analysis may aid in identifying the...
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| Format: | Article |
| Language: | English |
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BMC
2025-04-01
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| Series: | BMC Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12873-025-01206-y |
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| author | Kamran Idris Zainab Mubeen Zeeshan Noor Shaikh Aswad Latif Shaheryar Hasan Arshia Khan |
| author_facet | Kamran Idris Zainab Mubeen Zeeshan Noor Shaikh Aswad Latif Shaheryar Hasan Arshia Khan |
| author_sort | Kamran Idris |
| collection | DOAJ |
| description | Abstract Background Healthcare improvement at all levels involves systematic and continuous assessment of the system’s operations, efficiency, and effectiveness to ensure quality care. Likewise, in Emergency Medical Services; performance measurement and root cause analysis may aid in identifying the system inadequacies and address potential shortcomings by developing Key Performance Indicators. In this paper, we propose a tailored framework to supplement the performance measurement and healthcare improvement, primarily to monitor the quality of EMS operations and personnel for ambulance transfers, which results in patient collapses in ambulances. Methods We developed a Performance Measurement Framework (PMF) based on three essential domains– Structure/System, Process, and Outcome. Each domain was further assigned with different KPIs to assess the performance of EMS operations and personnel during patient transfers. The framework was pilot-tested for one year from January to December 2023, where its use was limited to the cases of patient collapse in ambulances, also referred to as out-of-hospital deaths. To assess progress, we compared the incidence of CIA between the pre-implementation and post-implementation phases, with service operational metrics including coverage, fleet size, workforce, and response times. Result Using the PMF as a tool for quality improvement, we observed a 7% reduction in the incidence of patient collapse in ambulances and a 16% reduction in life-threatening cases resulting in CIA despite increases in service coverage (37%), ambulance workforce (32%), fleet (26%), and routine interventions (11%). A slight increases in response times indicate the greater service demands. Through pilot testing, we identified operational gaps including behavioral and communication issues, adherence to SOPs, and equipment management. Conclusion Overall, this paper proposes a performance measurement tool in the field of prehospital care for organizations to thoroughly assess and advance their operations toward healthcare improvement. The study highlights areas requiring improvement such as training guidelines, adherence to operating protocols, and resource optimization. In addition; the integration of technology and advanced training programs for the ambulance workforce may strengthen the overall EMS performance; thereby promising positive patient outcomes, and efficient service delivery and utilization. Trial registration Not applicable. |
| format | Article |
| id | doaj-art-d0340a00e235498c8784a0e6049da5d8 |
| institution | DOAJ |
| issn | 1471-227X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj-art-d0340a00e235498c8784a0e6049da5d82025-08-20T03:10:17ZengBMCBMC Emergency Medicine1471-227X2025-04-0125111010.1186/s12873-025-01206-yAssessment of ambulance interventions; proposal of a performance measurement framework for healthcare improvement in EMS response to patient collapseKamran Idris0Zainab Mubeen1Zeeshan Noor Shaikh2Aswad Latif3Shaheryar Hasan4Arshia Khan5Department of Research, Development and Education, Sindh Integrated Emergency and Health ServicesDepartment of Research, Development and Education, Sindh Integrated Emergency and Health ServicesDepartment of Research, Development and Education, Sindh Integrated Emergency and Health ServicesDepartment of Research, Development and Education, Sindh Integrated Emergency and Health ServicesDepartment of Research, Development and Education, Sindh Integrated Emergency and Health ServicesDepartment of Research, Development and Education, Sindh Integrated Emergency and Health ServicesAbstract Background Healthcare improvement at all levels involves systematic and continuous assessment of the system’s operations, efficiency, and effectiveness to ensure quality care. Likewise, in Emergency Medical Services; performance measurement and root cause analysis may aid in identifying the system inadequacies and address potential shortcomings by developing Key Performance Indicators. In this paper, we propose a tailored framework to supplement the performance measurement and healthcare improvement, primarily to monitor the quality of EMS operations and personnel for ambulance transfers, which results in patient collapses in ambulances. Methods We developed a Performance Measurement Framework (PMF) based on three essential domains– Structure/System, Process, and Outcome. Each domain was further assigned with different KPIs to assess the performance of EMS operations and personnel during patient transfers. The framework was pilot-tested for one year from January to December 2023, where its use was limited to the cases of patient collapse in ambulances, also referred to as out-of-hospital deaths. To assess progress, we compared the incidence of CIA between the pre-implementation and post-implementation phases, with service operational metrics including coverage, fleet size, workforce, and response times. Result Using the PMF as a tool for quality improvement, we observed a 7% reduction in the incidence of patient collapse in ambulances and a 16% reduction in life-threatening cases resulting in CIA despite increases in service coverage (37%), ambulance workforce (32%), fleet (26%), and routine interventions (11%). A slight increases in response times indicate the greater service demands. Through pilot testing, we identified operational gaps including behavioral and communication issues, adherence to SOPs, and equipment management. Conclusion Overall, this paper proposes a performance measurement tool in the field of prehospital care for organizations to thoroughly assess and advance their operations toward healthcare improvement. The study highlights areas requiring improvement such as training guidelines, adherence to operating protocols, and resource optimization. In addition; the integration of technology and advanced training programs for the ambulance workforce may strengthen the overall EMS performance; thereby promising positive patient outcomes, and efficient service delivery and utilization. Trial registration Not applicable.https://doi.org/10.1186/s12873-025-01206-yCollapse in ambulanceHealthcare improvementPerformance measurementPrehospital care |
| spellingShingle | Kamran Idris Zainab Mubeen Zeeshan Noor Shaikh Aswad Latif Shaheryar Hasan Arshia Khan Assessment of ambulance interventions; proposal of a performance measurement framework for healthcare improvement in EMS response to patient collapse BMC Emergency Medicine Collapse in ambulance Healthcare improvement Performance measurement Prehospital care |
| title | Assessment of ambulance interventions; proposal of a performance measurement framework for healthcare improvement in EMS response to patient collapse |
| title_full | Assessment of ambulance interventions; proposal of a performance measurement framework for healthcare improvement in EMS response to patient collapse |
| title_fullStr | Assessment of ambulance interventions; proposal of a performance measurement framework for healthcare improvement in EMS response to patient collapse |
| title_full_unstemmed | Assessment of ambulance interventions; proposal of a performance measurement framework for healthcare improvement in EMS response to patient collapse |
| title_short | Assessment of ambulance interventions; proposal of a performance measurement framework for healthcare improvement in EMS response to patient collapse |
| title_sort | assessment of ambulance interventions proposal of a performance measurement framework for healthcare improvement in ems response to patient collapse |
| topic | Collapse in ambulance Healthcare improvement Performance measurement Prehospital care |
| url | https://doi.org/10.1186/s12873-025-01206-y |
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