377 - Developing a national pediatric prehospital quality improvement dashboard: Consensus results of a modified Delphi process

Poster Number: 377
Publication Number: 377.325

Background: Quality improvement (QI) initiatives can use dashboards to track performance over time. The National Emergency Medical Services Information System (NEMSIS) collects standardized Emergency Medical Services (EMS) data from over 14,000 EMS agencies, providing public performance dashboards for opioid overdose, motor vehicle crashes, myocardial infarction, and heat illness. Despite capturing over 51 million patient care reports annually, there is currently no pediatric-specific NEMSIS dashboard.

Objective: Identify core clinical measures for a NEMSIS-derived pediatric prehospital dashboard.

Design/Methods: We convened a 16-member technical expert panel (TEP) from national professional societies and federal entities. The TEP included physicians, nurses, EMS clinicians, federal and state EMS officials, and NEMSIS staff. Candidate measures were identified through a review of resources from the National EMS Quality Alliance, Prehospital Guidelines Consortium, Pediatric Prehospital Readiness Project (PPRP), and a TEP survey. Candidate measures were screened to ensure NEMSIS compatibility. The TEP engaged in a modified Delphi process with sequential rounds of voting to determine consensus priorities and scored measures on a scale of 1 (lowest priority) to 5 (highest priority). Prioritization of candidate measures was based on scientific acceptability, importance to patient outcomes, usability in driving improvements, and feasibility to collect. Consensus was defined as 75% of the TEP rating a measure as ≥ 4.

Results: We identified 65 candidate measures. After three rounds of voting, we achieved consensus on 21 measures (Table 1). These measures covered a range of common pediatric prehospital conditions including airway management (5 measures), trauma (4), pain control (3), respiratory (3), cardiac arrest (2), anaphylaxis (1), shock (1), seizures (1), metabolic (1), newborn care (1), non-transport (1) and safe transport (1). Common reasons for excluding measures included: limited scientific evidence, measure complexity and redundancy. The TEP also agreed on filters to be applied to these performance measures to enable comparisons between similar agencies (Table 2).

Conclusion(s): Using a modified Delphi process a TEP reached consensus on 21 measures for inclusion on a public-facing pediatric prehospital quality dashboard. Most identified measures were process-based. Next steps include building, launching, and disseminating the dashboard (scheduled for 2024), then evaluation to ensure this resource is used for QI initiatives to improve pediatric prehospital care.