How Paramedics Could Improve Patient Care and Emergency Department Efficiency

By Kristyna Culp, MBA

In hospitals around the country, paramedics are often viewed as outsiders to emergency departments’ processes. But does this tendency obscure opportunities to improve patient outcomes? Today, some researchers are seeking to streamline communication between paramedics and nurses to explore new opportunities to deliver better care.

A Shared Instrument

The Medical Director of the Winnipeg Fire and Paramedics Service, Dr. Rob Grierson, has led exploratory work on the topic. Grierson hypothesized that educating the city’s paramedics on a standardized triage instrument might help them communicate more effectively with nurses.

After instructing Winnipeg first responders in the use of the Canadian Triage and Acuity Scale (CTAS), Grierson found that they were able to apply the instrument effectively, and more consistently assess and communicate patient acuity levels. Based on this success, Grierson has continued the experiment with an expanded project encompassing thousands of patients. And he has inspired research along the same lines in the United States.

More Collaboration

A one-time paramedic and Ph.D. candidate at the University of Virginia School of Nursing, Todd Smith, is exploring whether first responders in the United States could use the Emergency Severity Index (ESI)—or the CTAS—in a way similar to Winnipeg paramedics. The goal? More collaboration in the ED.

“I’ve seen significant amounts of wasted time and duplicated efforts,” says Smith. “I think it’s often caused by the fact that nurses and paramedics aren’t always able to communicate well with each other.”

Communication between first responders and nurses is subject to a range of challenges. Nurses might not take information from paramedics seriously, or paramedics might deliver inadequate reports. Whatever the cause, the result of such communication breakdowns can be serious for patients. Wasted and doubled efforts or muddled communications can significantly impact the quality of care. And these preventable problems occur even as all parties work to deliver the best outcomes possible. “In my experience,” Smith says, “this type of disconnect generally lengthens the patient’s stay unnecessarily.”

Shared Education

The first stage of this work involves establishing baselines, testing paramedics’ ability to use the ESI and CTAS without comprehensive education in the tools. Smith found that his subjects could make accurate assessments of critical patients, but struggled with more nonspecific complaints like abdominal pain.

Now it’s time for the next step, and the big question: How will the situation change when paramedics are given the proper training? Smith contends that the common language of shared education – and shared tools — could lead to more effective emergency departments around the country.

“My hope,” says Smith, “is to show that paramedics in the U.S. are willing and able to be trained up to a higher standard of care, so they can work more collaboratively with nurses, nurse practitioners, and physicians.” And with further research, patients may reap the benefits of this education.

Kristyna Culp, MBA is a Managing Principal and Director of Operations at FreemanWhite. She specializes in transforming complex operations into manageable, efficient systems.