Innovations in Patient Care Episode 6 Interview with Dana Yost

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Innovations in Patient Care Episode 6 Interview with Dana Yost

transcript of Interview of Dana Yost

Jamie Davis: Hi, I’m Jamie Davis, the Podmedic. I’m doing some interviews here for Physio-Control at EMS Expo 2010 in Dallas. I’m here with Dana Yost, the paramedic from Seattle, Washington—King County area—actually Redmond, Washington, with the Fire Department?

Respondent: Correct.

Jamie: Before we get into talking about your presentations today because you’re doing some really engaging talks today about some CPR QI and I really want to find out a little bit about that. Before we do that, what got you into being a paramedic? How did you reach the point now where you’re so passionate about this?

Respondent: Sure. Back in 1987, I was living next to my neighbor who was a volunteer fireman. He says to me, he says, “Hey, what do you think about joining the volunteer fire department?” I said, “Oh, sure.” I did and they put me through an EMT class and from there I just kind of graduated up slowly into about 1995. I went to the Harborview Paramedic program in Seattle. I came over to Redmond Medical on which is part of the Seattle–King County Medical System.

Jamie: King County is really, I think, one of the—if not the leader—one of the nation’s leaders in really pushing the envelope on increasing and improving cardiac arrest survival. You’re talking about something called “CPR fraction time”?

Respondent: Sure.

Jamie: Now that’s going to be part of your presentation and you’re talking about quality improvement of how we handle CPR in cardiac arrest. What do you mean? That term left out at me when I was looking at your presentation.

Respondent: Sure. It’s a fancy term for hands-on time for your CPR event. Start zero of the cardiac arrest all the way to the end, the question is how much compression time are you actually hands-on on the patient. I think there’s some pretty [startling] evidence that suggests that that is really a core foundation of resuscitation. If you can figure out ways to increase your CPR fraction time or your hands-on time, as an easy way to say that, it’s an easy way to increase your resuscitation rates.

Jamie: What have you found? Is the resistance to looking at these numbers—I’m always intrigued by the fact that when you talk to some systems, they try to still do things by flying by the seat of their pants. By doing the things that just seemed like a good idea rather than actually looking at numbers and saying, “This is working; this is not working,” and comparing the way they’re running things. King County, obviously, has found a way to make all this work. As you talk to other people from other systems, are you finding that they just haven’t caught on to this or is this just something that’s so new that there’s—well, this has been around for five years. We know more about the launch of the new guidelines—hands-on CPR compressions have been around since 2005 Guidelines came out. It’s not that new but yet systems are still not fully implemented.

Respondent: It’s definitely not a new concept. It requires a lot of work. It requires a lot of work to collect that kind of data. It requires a rigorous attention to detail to collect that kind of data. Fortunately, I’m fortunate enough to live in a system where I grew up collecting data. I can tell you last year on our medic unit we had six studies at the same time on the medic unit which is an enormous amount of work on top of doing your patient care and everything else that you’re supposed to do. It’s a culture that makes the difference I think. People with passion who say, “I’ve seen that collecting data makes a difference. That we can make reasonable decisions based off of good data and makes it worthwhile.”

Jamie: What’s the number as you were doing your study and the things you’re presenting today—when you’re doing your presentation which people would be able to find eventually over at the Physio University site, the presentation today, what’s the number when you do this presentation that leaps out at you? The one that you just look at that maybe caught you by surprise or means the most to you when you’re looking at numbers associated with cardiac arrest survival.

Respondent: A lot of the projects I’m going to talk about in the lecture today is based on a problem. We found that we have a problem. Even in the best EMS systems, the reason why they get better is because they realize that they can still grow. King County is no exception to that. Even with a high resuscitation rate, we’re looking for the next leap. We’re trying to figure out what is the next thing that is going to increase our resuscitation rates. Even being near the top of the hill, we don’t stop at that point. In my agency, although our CPR fraction times were very high compared to the national standard, they weren’t very high compared to King County—the rest of the organizations within King County. That posed a problem for us. We just needed to sit down and figure out a way to solve it and this was the way we solved it.

Jamie: It really is pulling the numbers and actually really looking at how we’re managing codes and how we’re having people aware of staying on top of being on the chest and not getting off the chest. Of course, the new guidelines—there’s a lot of rumors about what they’re specifically going to say. Some of us have an inkling. If we’ve been looking at the research, it shouldn’t be too hard to figure out but the focus has not changed. We’re not going to see anything about that really changed as far as the focus being on high-quality consistent compressions. It is not going to be any different. When you move forward and you look at that, what did your system do to implement change? You’re already in a culture that is focused on that but you still found you could improve. There really is room for improvement no matter what it is you’re doing.

Respondent: That’s true. Basically, what we did was we sat down, looked at what the problem was which in our minds was a lower than the standard CPR fraction time in in King County and said, “What can we do to change that?” We try to take a multi-pronged approach to that looking at increasing awareness among the providers, giving feedback readily, urgently, so they could see what they did good and what they did that they could work on. We implemented some training. We saw a dramatic difference even a six-month period. I’m confident now—and the reason why I wanted to talk about this is I’m confident now that the system that we are using right now can be duplicated very easily. It requires a little bit of manpower and hard work and initiative. There’s no rocket science involved in what we’re doing and it can easily be duplicated by other EMS agencies.

Jamie: Well, fantastic. I think everybody should take an opportunity to get over to Physio University and check out the Learning Center sessions here from EMS Expo in Dallas 2010 and thanks again to Physio-Control for enabling me to come down here and have interviews with great minds in paramedicine like Dana Yost.

Respondent: Thank you.

- End of Interview -