The arbitrary value of time as a key quality indicator for EMS care: An observational study using the SPART model on the relationship between time and clinical reasoning activities by EMS providers.

Abstract

Abstract Background Time is a key quality indicator for EMS care, and many efforts are directed at minimizing the time used for response, on-site and transport periods. In some deployments, this is undoubtedly justified, but in many medical situations, time might be overestimated as a quality indicator. To assess the value of time as a quality indicator, we conceived a study to investigate the relationship between EMS clinical reasoning processes and the variable time. Methods Using video recordings of EMS deployments, we qualitatively identified professional activities, determined their time of execution within a deployment and measured the duration of these activities. The observed activities were classified using the SPART model, which identifies ten categories in the EMS care process. We assigned each diagnostic and treatment activity to a category. The measured time variables were interpreted both qualitatively and by using descriptive statistics. Results We identified 1683 activities (total duration 12h34m30s, 28 clinical cases, 20 participants). Diagnostic activities took 4.3 times more time than therapy. The diagnostic process sometimes continued after the clinical decision had been made, but this did not alter the decision taken. Conclusion Our observations showed that most of the time was spent on the diagnostic process leading to a clinical decision. Sometimes, this process was terminated too early, and the clinical decision seemed to be taken too soon. This phenomenon is known as premature closure (a hypothesis is considered final before all evidence is searched for and evaluated), possibly negatively affecting the quality of care. We speculate that this cognitive bias could be minimized if the deployment duration is considered less critical, an issue we feel warrants further research.