«Goal: The Advance, Implementation and Appraisal of Evidence-Based Guidelines (EBGs)» - Free Essay Paper
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The aim of the advance, implementation, and appraisal of evidence-based guidelines (EBGs) is defined by the National Prehospital EBG Model Process. These guidelines should serve as an essential component of the selection of conditions required for the development and implementation of the hospital based-EMS and the maintenance of the payment decisions for development and implementation of the data-driven and evidence-based EMS systems. The increased consumer demand for quality and cost-effective health care systems has led to the greater emphasis on development of the data-driven and evidence-based EMS systems. Evidence-based EMS systems are essential in promoting an excellent health care system (Eddy et al. 2012). This goal is achieved by the transition from the traditional intuition-based paradigm to the evidence-based EMS systems.
Currently, the evidence-based guidelines provide several strategic objectives to the realization of the EBS paradigm. However, there are challenges that come with the execution of these objectives. This paper starts by looking at the challenges that the developers face and gives some suggestions on how these challenges can be solved. This paper will focus on the Emergency Medical Services (EMS) systems. The conclusion of this paper offers opinions about the question whether the National Prehospital EBG Model Process might fail while trying to deal with software challenges associated with the Model Driven Development Paradigm.
Strategic Objectives Implementation, Challenges Involved and How to Solve Them
The first objective of implementing the listed strategic objectives of the goal mentioned in this topic is the support for the development, implementing, and evaluation of evidence-based guidelines (EBGs). This objective is realized by starting with data collection and research to allow for the creation of secure EBGs (Eddy et al. 2012). This process is the guideline, which is implemented to provide a sound foundation of data and research. The mentioned implementation ensures such vital issues as patient’s care coordination, promoting effectiveness of the healthcare, training of the workforce, as well as provision of a greater integration of the hospital and prehospital EMS systems.
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The varied changeability of the EMS care is the main challenge that affects the implementation of this objective. Providing a multidisciplinary approach to the EBG’s development would help to tackle that challenge. The 8-step process of the evidence-based guidelines development provides a comprehensive and multidisciplinary approach.
Another objective is the quality improvement and data standardization for EMS systems. The adoption of National EMS Information System (NEMSIS) compliant systems is instrumental for implementing this objective (Eddy et al. 2012). The collected data must be easily accessible and standardized, because it relied on in the implementation of EMS systems in the prehospital setting.
The challenge that affects the implementation of this objective is the lack of uniformity while assessing the quality of prehospital care. This challenge can be resolved by facilitating the nationwide data standardization. NEMSIS should, therefore, support the FICEMS as it endeavors to encourage gathering of the data which relevant and reliable to the prehospital environment in such areas as outpatient treatment or transportation of patients to the hospitals or to their homes (CFECUHS, 2006).
Another objective is the development of relationships between the federal and non-federal participants for the improvement of evidence-based guidelines for EMS systems. There are many stakeholders that are involved in the development of scientific evidence for prehospital care. Federal Interagency Committee on EMS (FICEMS) has a huge responsibility of establishing the relationships with those stakeholders with an aim of fostering a successful objective implementation.
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The main challenge is the lack of scientific evidence to support the numerous employed EMS clinical procedures and EMS system’s design features. Examples of the lack of such scientific evidence, according to IOM, include cardiac resuscitation and rapid sequence intubation. In its 2006 report, IOM found out that the lack of scientific evidence in prehospital care environments leads to strain in research as well as delays in the development of effective performance measures (Eddy et al. 2012). This challenge can be resolved by ensuring that the hundreds of the existing EMS agencies of diverse types and sizes are partnering with primary care physicians, hospitals, nurses and other social services providers with the goal of implementing innovative programs that foster better levels of care.
Another objective involves improvement of linkages between the data stored by the NEMSIS and other registries and databases to ensure the systems’ effectiveness and measures for the improvement of the clinical outcomes. A need exists to integrate the NEMSIS data with other data sources. This approach would help to produce a dynamic and robust information system. NEMSAC has played an important role in compelling the NHTSA and FICEMS to implement a nationwide integration of EMS illness, injury and fatality databases across hundreds of EMS agencies. NEMSAC has also stated the importance of the data linkages and bi-directional data flow (CFECUHS, 2006).
A major challenge is the fact that data connectivity among EMS stakeholders at the state level is often deficient or non-existent. FICEMS is the agency that is faced with the responsibility of promoting integration of the locally-based NEMSIS compliant data with the state-based data sources (CFECUHS, 2006). Examples of state data sources include hospital data and police reports. To resolve this challenge, it is important for the local and state EMS agency to partner in order to facilitate, interpret, apply and receive acceptance of the medical direction authorities. These linkages are important for ensuring enhanced research efforts and providing a broader outlook on the Emergency Medical Services (EMS) systems. The potential partners in this linkages of enhanced data with NEMSIS include the National Trauma Database, Health Level Seven International data and the Cardiac Arrest Registry.
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Promoting evaluation of the EMS system’s characteristics is yet another objective in the process of implementation and evaluation of the evidence-based guidelines for Prehospital Care. These characteristics are associated with high quality health care that aims to improve the patients’ outcomes (CFECUHS, 2006). The main challenge associated with the implementation of this objective is the effectiveness of monitoring local EMS systems. Although Emergency Medical Services (EMS) systems are frequently a first point of entry for the patients, their performance is not well-monitored routinely and their documentation is not well-kept. To solve this challenge, an evaluating team is needed to monitor the key performance indicators of EMS systems and document the progress of that performance efficiently. This approach would ensure an instructive guideline for Emergency Medical Services (EMS) systems. Such performance measures would also be instrumental in assessing the EMS system’s performance and benchmarking that performance against the national metrics.
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The last objective is to explore how technology is utilized with the goal of enhancing sharing of information for improving operational efficiency, safety and situational awareness of the health care. Enhancing information sharing that relates to such issues as weather and geography is helpful by aiding the EMS personnel, who are on the ground, to enrich situational EMS (CFECUHS, 2006). It is important to note that usability capabilities of the EMS systems enable the systems to respond to questions, ask for clarifications and give recommendations. All these elements are important, as they guide during the decision-making process. For instance, an increment of rainfall may cause difficulty of movement for emergency vehicles and the patients’ transportation into the ambulances.
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The main challenge involved in the implementation of this objective is incorporating technology into the health care practice. The reason is high initial costs, labor and time required to implement EMS (Eddy et al. 2012). This challenge can be overcome by incorporating technology so as to enhance information-sharing despite high initial costs. Such decision would increase overall hospitals’ revenue and the profitability of using EMS systems would be higher than the operating expenses within 2-3 years of use.
In 2008, the National Conference of EMS experts and stakeholders that was sponsored by NEMSAC, NHTSA and FICEMS developed the National Prehospital EBG Model Process. The National Prehospital EBG Model Process provides a multidisciplinary and a comprehensive approach for the development and implementation of EBGs for prehospital care. This paper has revealed that incorporation of evidence based guidelines into local and regional prehospital review process results in improved prehospital care. Despite various challenges that come with the implementation of strategic objectives of the realization of the EBS paradigm, a standardized method capable of evaluating and summarizing the quality of strength and evidence of recommendations is inevitable. For this reason, such processes as development, implementation, and evaluation of EBGs for EMS systems should be encouraged in prehospital care.
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