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Introduction

The goal of the Patient Transfer of Care Off-Load Time Dashboard is to provide State Data Managers and selected Federal Officials with information about the off-load times that EMS is experiencing.

This user guide provides details on the Patient Transfer of Care Off-Load Time Dashboard.

The NEMSIS Patient Transfer of Care Off-Load Time Dashboard includes, within the defined timeframe, all EMS activations in which the Type of Service Requested [eRespsone.05] is 911 Response (Scene) AND Type of Destination [eDisposition.21] is Hospital-Emergency Department. An activation is an occurrence which initiates an EMS response with the potential of patient medical care. This is also referred to as an EMS “call” or “run”.

Global Inclusion Criteria and Filters

The global inclusion criteria defines the minimum characteristics each event record must meet in order for it to be included in any of the calculations for the Patient Transfer of Care Off-Load Time Dashboard. For details on each element, its code, and range of values see the NEMSIS Version 3.4 Data Dictionary.

For this dashboard, the inclusion criteria are as follows:

Patient Criteria

Priority 1 Patients are defined as:

eDisposition.17-Transport Mode from Scene

  • 4217001 Emergent (Immediate Response)
  • 4217007 Non-Emergent Upgraded to Emergent

OR

eDisposition.24-Destination Team Pre-Arrival Alert

  • 4224003 Yes-Adult Trauma
  • 4224005 Yes-Cardiac Arrest
  • 4224007 Yes-Obstetrics
  • 4224009 Yes-Other
  • 4224011 Yes-Pediatric Trauma
  • 4224013 Yes-STEMI
  • 4224015 Yes-Stroke
  • 4224017 Yes-Trauma (General)

OR

eDisposition.19-Final Patient Acuity

  • 4219001                Critical (Red)

OR

eVitals.03-Cardiac Rhythm

  • 9901051                STEMI Anterior Ischemia
  • 9901053                STEMI Inferior Ischemia
  • 9901055                STEMI Lateral Ischemia
  • 9901057                STEMI Posterior Ischemia

OR

eVitals.29-Stroke Scale Score

  • 3329005                Positive

OR

eInjury.03-Trauma Center Criteria, Level 1 or Level 2 Trauma Center

  • 2903001                Amputation proximal to wrist or ankle
  • 2903003                Crushed, degloved, mangled, or pulseless extremity
  • 2903005                Chest wall instability or deformity (e.g., flail chest)
  • 2903007                Glasgow Coma Score <= 13
  • 2903009                Open or depressed skull fracture
  • 2903011                Paralysis
  • 2903013                Pelvic fractures
  • 2903015                All penetrating injuries to head, neck, torso, and extremities proximal to elbow or knee
  • 2903017                Respiratory Rate <10 or >29 breaths per minute (<20 in infants aged <1 year) or need for ventilatory support
  • 2903019                Systolic Blood Pressure <90 mmHg
  • 2903021                Two or more proximal long-bone fractures

All patients are defined as:

All patients that pass the inclusion criteria but do not qualify as Priority One plus all the Priority One patients.

Time Inclusion Criteria

There are two times used in the dashboard to describe off-load times.

APO Time is Ambulance Patient Off-load Time. APO Time is defined as Destination Patient Transfer of Care Date/Time (eTimes.12) MINUS Patient Arrived at Destination Date/Time (eTimes.11). The inclusion criteria include:

  • Global Inclusion Criteria, the minimum characteristics each event record must meet in order for it to be included in any of the calculations for the Patient Transfer of Care Off-Load Time Dashboard;
  • Valid Destination Zip Code: a destination zip code that exists within the state that submitted the record;

AND

  • Valid Elapsed Time: an elapsed time between 0 and 12 hours.

Turn-Around Time is defined as Unit Back in Service Date/Time (eTimes.13) MINUS Destination Patient Transfer of Care Date/Time (eTimes.12). The inclusion criteria include:

  • Global Inclusion Criteria, the minimum characteristics each event record must meet in order for it to be included in any of the calculations for the Patient Transfer of Care Off-Load Time Dashboard;
  • Valid Incident Zip Code: an incident zip code that exists within the state that submitted the record;

AND

  • Valid Elapsed Time: an elapsed time between 0 and 12 hours.


Elements of the Dashboard

This dashboard includes a map with three dropdowns, a date slider, and map legends. Information on other record specific elements can be found in the underlying data set, accessible though the Tableau tooltip. The dashboard contains 30 days of historical data.


State Dropdown

The State Dropdown is based on Incident State (eScene.18). Selecting a state from the dropdown allows you to filter to just that state’s information. As a State Data Manager, only your state will be visible in the dropdown.

Patient Status Dropdown

The Patient Status Dropdown allows you to filter the map by All Patients or by Priority One Patients.

Elapsed Time Dropdown

The Elapsed Time Dropdown allows you to filter the map by Ambulance Patient Off-load Time (APO Time) or Turn-Around Time.

Dispatch Date Slider

The Dispatch Date Slider is based on Unit Notified by Dispatch Date/Time (eTimes.03). The slider allows you to filter the map by a specific timeframe.

Map Legends

The Map Legends provide detail about the information on the map. The legends change depending on the patient selection from the Patient Status Dropdown. There are four maps with corresponding map legends: APO Time for Priority One Patients, APO Time for All Patients, Turn-Around Time for Priority One Patients, and Turn-Around Time for All Patients.


APO Time for Priority One Patients


Map colors for APOT for Priority One Patients are based on the percentage of APOT above/below a threshold for each Destination Zip Code (eDisposition.07).


RED indicates => 10% of APO times are > 30 minutes.

YELLOW (gold) indicates => 5% AND < 10% of APO times are > 30 minutes.

GREEN indicates =< 5% of APO times are > 30 minutes.



APO Time for All Patients


Map colors for APOT for All Patients are based on the percentage of APOT above/below a threshold for each Destination ZIP Code (eDisposition.07).



RED indicates => 10% of APO times are > 60 minutes.

YELLOW (gold) indicates => 5% AND < 10% of APO times are > 60 minutes.

GREEN indicates =< 5% of APO times are > 60 minutes.



Turn-Around Time for Priority One Patients


Map colors for Turn-Around Time for Priority One patients are based on the percentage of Turn-Around Time above/below a threshold for Destination ZIP Code (eDisposition.07).



RED indicates => 10% of Turn-Around times are > 40 minutes.

YELLOW (gold) indicates => 5% AND < 10% of Turn-Around times are > 40 minutes.

GREEN indicates =< 5% of Turn-Around times are > 40 minutes.



Turn-Around Time for All Patients


Map colors for Turn-Around time for All Patients are based on the percentage of Turn-Around Time above/below a threshold for Destination ZIP Codes (eDisposition.07).



RED indicates => 10% of Turn-Around times are > 40 minutes.

YELLOW (gold) indicates => 5% AND < 10% of Turn-Around times are > 40 minutes.

GREEN indicates =< 5% of Turn-Around times are > 40 minutes.


Tableau Toolbar

All Tableau dashboards share the same toolbar at the bottom of the view. Note that while most dashboards will have the same selections, some items may differ based on user permissions.

Undo, Redo, Revert, Refresh and Pause

These selections are found on the left side of the Tableau toolbar and can be used to help navigate the dashboard.


Undo will remove the last selection made, if you have used undo to remove a selection, you can then use redo to return to that selection. Revert returns the dashboard to its original view. Refresh will reload the data on the dashboard subject to any selections made. Pause will stop the dashboard from refreshing as you make selections.

As an example, if you want to make a set of complete selections in a dashboard’s filters, you could use these buttons to speed up the process. Normally, every time a change is made, the dashboard will refresh. If you select “Pause” however, the dashboard will remain the same no matter how many selections you make. Once you have made all your selections, you can select “Refresh” to reload the dashboard based on those selections.

Subscribe, Custom Views, Edit, Share, and Download

These selections are found on the right side of the Tableau toolbar and can be used to interact with the dashboard in external ways.


The Subscribe button allows users to subscribe to a daily or weekly email that will show a static image of the dashboard as well as a link to the view.

You can select either a particular view (tab) or all the views (tabs) available in the dashboard. Under “Email Subscriptions,” you can choose the frequency of emails. In “Subject Line,” you can assign the subject for the emails. As a default, the subscription will be assigned to the email address associated with your NEMSIS account.

Custom Views allows users to save any particular set of filters or selections for quick access later. A user can create their view and then name it and save it either for their own personal use or use by anyone with access to this dashboard. Previously saved views will appear in the custom views tab.

Edit will open the dashboard in the web editor for Tableau. Note that this option is not available on all dashboards and will require some knowledge of how to use Tableau to build and edit dashboards.

Share will provide a couple of options for sharing the dashboard with others, specifically an embed code and a regular HTML link. While you can use the link to share the dashboard with others, please keep in mind that many of the NEMSIS dashboards will require a username and password. Only those with credentials will be able to access them.

The last option is Download. Clicking on the download button opens up several options to download either the workbook, the data within it, or a static image of the view.

Selecting any one of these file types will produce a download of the requested file. Remember that not all options will be available for all dashboards and views.

Contact Info

Any questions, comments, concerns, or suggestions regarding this or other reports made available by the NEMSIS TAC, please contact us or leave a comment below!

Contact information is also available on our website.

Kevin White, BS
University of Utah School of Medicine
NEMSIS Technical Assistance Center
Phone: (801) 213-3408
Fax: (801) 581-8686
Email: kevin.white@hsc.utah.edu
Atim Effiong, MPH
University of Utah School of Medicine
NEMSIS Technical Assistance Center
Phone: (801) 585-9158
Fax: (801) 581-8686
Email: atim.effiong@hsc.utah.edu 
Laurel Baeder, BA, MStat
University of Utah School of Medicine
NEMSIS Technical Assistance Center
Phone: (801) 587-5337
Fax: (801) 581-8686
Email: laurel.baeder@hsc.utah.edu





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