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The EMS Run Report
Transcript of The EMS Run Report
Changes During Transport
If a twenty minute transport is summarized in two sentences you should be scratching your head. Encourage your crews to comment on the patient condition and document that vital signs remained unchanged throughout the trip. If the crew did not document these items, one could infer no history or vital signs were taken during the transport.
A Few Words on Abbreviations
Who doesn't love abbreviations? Later when we are reading the run report, these might actually be more confusing then helpful. For instance:
A "Good" Report
Let's look at the EMS Run Report. By now, you are familiar with the run report and probably sign off on these documents several times a shift.
State law requires that the run report contain information such as:
Patient identifiers (name and date of birth)
Basic set of vitals (BP, RR, HR)
Medications delivered on board the ambulance
No surprises here, if you want more details see the 202 KAR 7:540 attachment in the module folder. An adequate run report would include all this information, but not a very useful one.
The run report has the potential to go beyond these registration items and that is where the medical director comes in.
A great report also...
Introduces the patient's condition, highlights pertinent history for other providers and paints a picture.
Unfortunately, very little information is shared on this topic in the EMS classroom. When utilized correctly, the run report can enable ambulance providers to reflect on their medical decisions when things are more calm. Improving patient care is just one of the few reasons the medical director is involved in this process.
Good documentation habits will lead to great reports that allow you to revisit scenes and access the quality of patient care being delivered by your crews. Let's expand beyond just a "good" report...
Lawsuits are something no healthcare provider wants to think about. EMS can protect themselves the same way physicians do through good documentation. A good report from the day of the event is the best evidence in a court room. As far as attorneys are concerned, if it was not written down... care was not provided.
Is descriptive enough to ensure appropriate billing
Can serve as a legal record of the transportation event in the case of a lawsuit
Will allow the medical director to retrospectively assess the scene
A paramedic could describe this scene as an accident. This could mean a variety of things to future providers. The hospital would be better prepared if the report included an extrication or a passenger who was dead on arrival. The run report is also a great place to briefly summarize damage to the car. A description of damage will help the hospital predict the locations of major injuries.
Emphasize to your crews that this scene needs to be better described. In this case, encourage your crew to write that the condition of the home made it hard to move the stretcher through and many items had to be moved out of the way. A simple sentence could clear up any questions about time spent on the scene.
An important question to ask while accessing the run report is: Did your providers describe the scene and transport adequately enough that there are no unanswered questions? We can work through some examples here.
You are reviewing a run report and you notice a twenty minute on-scene time with no explanation. You should be curious what took the crew so long to get the patient onto the ambulance. When you ask your crew about it they describe the following scene....
This is a great time to pause and offer some food for thought. When you are discussing scenes like this with your crew it might be worth bringing up questions about the patient's living condition. Was the patient living alone? If they were injured in this home, how did they get to the phone? How long were they down? Answers to these questions could help future providers map out a time-line and contribute to injury management. Also, remind your crews that they will often be the only providers who have insight to the patient's true environment or situation.
Run reports are a great place to start a quality improvement discussion with your crews. Examining topics like those covered in this module with your crews will both strengthen your team and ultimately improve pre-hospital patient care.
Let's examine another scene....
While we are the tedious topic of billing, let's cover a few other nit-picky items...
=Primary Care Provider=Angel Dust
=Ruptured Open Membranes=Range of Motion
Yes, this completely discounts context but you get the drift. On a written report, legibility can even further confuse these abbreviations...
You are reviewing a patient history with your medic and he isn't sure if that is a U or V. Although the difference between peripheral vascular disease or peptic ulcer disease may seem trivial, this could turn out to be the only patient history the hospital has.
Say you encounter a report that describes a sudden switch from non-emergent to emergent status, a scene intervention by another provider or a call for helicopter support. To keep it basic, in the situation where an ambulance stops or starts moving faster you should expect your crew to describe and justify the change. If your crew makes sound medical decisions, encourage them to further support these decisions through great documentation. Sound medical decisions on the part of your crew demonstrate preparedness and strong medical direction.
Click through this module at your own pace before completing the Run Report Assessment
The Lawsuit "R's"
The crew must document if a patient refuses any component of care. If the medical director does not see routine management documented in the report (or a refusal), they could conclude that the paramedic failed to uphold standards of care. Additionally, non-standard practices, such as placing an anxious patient on oxygen simply as a means of reassurance that they are being cared for, need to be described. This prevents confusion when going over the report later. In the previous example, we don't want providers to assume there are undocumented respiratory issues.
This maybe a topic less considered, but billing is certainly important to the patient. A patient's medical condition must be well-documented in order for insurance to cover the transportation. This occurs frequently with non-emergent transports. Think about a prone patient recovering from back surgery. If this situation is not outlined by the run report, insurance companies will wonder why the patient did not take a wheel-chaired van to the doctor's office.
Picture an unresponsive patient with no medical history. The astute medic would record observations like an insulin magnet on the refrigerator or an aggressive animal on the premises. This information can hasten arrival at a diagnosis when the patient is being treated later.
Similar to situations in the hospital, restraints must be justified. If a report merely says restrains were used, but fails to describe why the decision was made, you should point that out to your crews. Encourage them to describe the patient's disposition, whether the agitation occurred before or during the transport, and if the patient harmed the crew.
Three situations were lawsuits can rear their nasty heads if they go undocumented
Non-patients on board, including family members, must be accounted for and it might be helpful to describe where they were in the ambulance. This is an extreme example, but let's say a patient coded during a transport with a parent on board. In court, the parent claims the crew reaction was poor. However, if the parent was documented in the front passenger seat, their field of vision would have been too obstructed to visualize the back of the truck.
Remind your crews to document thoroughly during refusals. Just writing the patient refused is not adequate in these situations. Like other situations we have discussed, a medical director can assume that the risks of refusing care were not shared with the patient if they are not documented. This can be avoided by simply including a statement such as: "The patient was informed of all the risks associated with refusing care, advised to call 911 or the station if their situation changes, and to follow up with their primary care physician this week."