title: The effect of a quality improvement feedback loop on paramedic-initiated nontransport of elderly patients.
abstract: OBJECTIVE
  To examine the effect of a paramedic educational program and quality improvement feedback loop on paramedic-initiated nontransport of patients 65 years of age and older.
  
  
  METHODS
  Prospective observational study. Patients 65 years of age and older who were evaluated but not transported by paramedics were contacted by telephone within two weeks of emergency medical services (EMS) contact and asked: 1) whether the patient sought medical help within 24 hours after contact; 2) whether the patient was admitted to a hospital and, if so, what was the diagnosis; 3) who was responsible for the nontransport decision (patient, paramedic, or mutual); and 4) how satisfied the patient was with the EMS service. After six weeks of data collection, the results were presented in a nonjudgmental fashion to the paramedics. After this intervention, the data collection continued for another five weeks without the paramedics' knowledge.
  
  
  RESULTS
  After the intervention, the overall nontransport rate remained constant (11.5% vs. 10.7%). The percentage of patients seeking further medical attention within 24 hours also remained constant (37.1% vs. 33.9%). The percentage of patients who required hospitalization within 24 hours of the nontransport declined from 12.6% to 6.4%. The percentage of patients who refused ambulance transportation by paramedics declined from 9.3% to 3.7%. Overall satisfaction level rose from 94.7% to 100%.
  
  
  CONCLUSIONS
  When paramedics were provided with objective feedback regarding outcome of patients not transported, the paramedic-initiated nontransportation and delayed hospitalization rates decreased, and the patient satisfaction level rose to 100%.
authors.affiliation: City of Houston Emergency Medical Services, TX 77007, USA. david.persse@cityofhouston.net
authors.forename: David E
authors.initials: DE
authors.lastname: Persse
authors.forename: Craig B
authors.initials: CB
authors.lastname: Key
authors.forename: J Benjamin
authors.initials: JB
authors.lastname: Baldwin
mesh_terms: D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians; D006801:Humans; D017060:Patient Satisfaction; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires; D013781:Texas; D014187:Transportation of Patients / Q000706:statistics & numerical data*