Notes from the Academy of International Mobile Healthcare Integration (AIMHI) webinar Measuring (& Improving) What Matters
For decades, EMS has been exceptionally good at measuring activity. Response times, transport volumes, scene times and unit utilization can all be tracked with extraordinary precision. But those measures do not necessarily answer the question that matters most: Did the care we provided improve the patient’s outcome?
That question was at the heart of the Academy of International Mobile Healthcare Integration (AIMHI) webinar, Measuring (and improving) what matters, featuring Danielle Geronimo, QA/QI manager at Richmond Ambulance Authority; Dimitra Tsaklanos-Geraghty, community paramedic program manager at Northwell Health; and Elizabeth Quellhorst, director of operations and quality at Northwell Health Center for Emergency Medical Services.
The discussion challenged EMS leaders to distinguish between measures that describe activity and those that demonstrate value.
| MORE: New EMS benchmarks challenge the industry’s focus on response times
Response time matters, but it isn’t quality
Quellhorst argued that we should not stop measuring response time, particularly for cardiac arrest, airway compromise and major trauma. The problem is treating average response time as a universal definition of EMS quality.
“The question shouldn’t simply be how fast did we get there,” she said, “but rather, did we actually improve the patient’s outcome?”
Better measures might include neurologically intact survival following cardiac arrest, functional outcomes after stroke, early recognition of sepsis and patient-reported experience.
Tsaklanos-Geraghty raised another way to measure quality: disposition appropriateness. Did EMS take the patient to the right facility? Did a 12-lead result in appropriate cath lab activation? Did stroke recognition get the patient to the appropriate stroke center? Could the patient have safely received care through community paramedicine, telehealth or another alternative pathway?
Geronimo reinforced the point with Richmond’s patient experience data. In 2026, patients ranked the care they received, concern and caring and professionalism as more important than response time. As Quellhorst summarized: “Patient experience is not separate from quality, it is quality.”
Follow the patient beyond the ambulance
One of EMS quality improvement’s biggest limitations has traditionally been that EMS insight into the patient’s outcome ends at the emergency department. Northwell has an advantage because EMS operates within a large health system, allowing its quality teams to follow patients into the ED and inpatient environment. Richmond uses the patient outcomes capability within ESO EHR to connect prehospital care with hospital outcomes.
That fundamentally changes the quality conversation. Instead of reviewing an EMS encounter solely through the PCR, agencies can examine the relationship between prehospital assessment, treatment and decision-making; and what subsequently happened to the patient.
It also changes how EMS and hospitals think about ownership of outcomes. Stroke and sepsis outcomes, for example, depend upon multiple parts of the healthcare system. Trying to determine precisely who gets the credit can become less important than understanding whether the entire system worked. “The endpoint is the patient and their outcome,” Quellhorst said.
Three examples of measuring what matters
The panel offered practical examples of how changing measures can change the understanding of performance. At Richmond, Geronimo focused on documentation and provider feedback. Rather than treating documentation as an administrative exercise, did the clinician complete every required field? The question of quality becomes whether the record allows the next clinician to understand what happened, why decisions were made and what the patient needed.
“Data by itself doesn’t change behavior,” Geronimo explained. “People change behavior when they understand what the data means and what they can do differently.”
At Northwell, Tsaklanos-Geraghty examined an approximately 10% increase in hospital transports within the community paramedicine program. The increase might suggest clinicians were becoming less successful at managing patients at home. Outcome data revealed something vastly different: 83% of the transported patients were admitted to the hospital. The increased transport rate was therefore not necessarily a quality failure. It demonstrated that community paramedics were identifying patients who genuinely required hospital-level care while continuing to keep appropriate patients safely at home.
Quellhorst described Northwell’s work with large vessel occlusion patients requiring transfer for mechanical thrombectomy. Rather than examining only the EMS component, the team mapped the entire patient journey and found that some of the biggest delays were process related.
Northwell introduced an “auto launch” process, starting ambulance movement while physician discussions and other transfer requirements occurred in parallel, rather than sequentially. The result was a 28% reduction in response time and a 24-minute reduction in average door-in-door-out time.
“Don’t just look at your piece,” Quellhorst advised. “Look at the whole thing and see what you can do.”
AI can expand the reach of quality improvement
Artificial intelligence could make comprehensive quality review possible at a scale that human teams simply cannot achieve.
Today, quality teams may manually review only a percentage of PCRs. AI could potentially examine every encounter, identifying documentation gaps, protocol deviations, medication variations and emerging clinical trends.
But the panel drew a firm distinction between assistance and replacement. An algorithm can flag a chart; it cannot necessarily understand the scene, the circumstances or what was going through a clinician’s mind. That requires human conversation, coaching and clinical judgment. AI’s value may therefore lie in allowing quality teams to find cases that require attention rather than replacing the people responsible for understanding them.
Quality improvement requires trust
Technology cannot fix a punitive quality culture.
“You can have the best data system in the world, but if your providers don’t trust the people using the data, you’ve got nothing,” Geronimo said.
The panel advocated a Just Culture approach: instead of beginning with “Who made the mistake?” ask why it happened and what could be changed to prevent it happening again. Accountability remains, but improvement rather than punishment becomes the default.
That also means recognizing excellent care. If clinicians hear from QA only when something goes wrong, the process inevitably feels disciplinary.
AIMHI President, Rob Lawrence reinforced that Just Culture must begin with leadership. Drawing on his experience at Richmond Ambulance Authority, Lawrence pointed to the influence of longtime medical director and qualified pilot, Dr. Joseph Ornato, who emphasized that medical directors and chief executives must establish an environment in which self-reporting, learning and system improvement are actively supported.
What will matter in 2030?
By 2030, the panel expects high-performing EMS systems to measure functional outcomes, appropriate disposition, avoidable healthcare utilization, patient experience, equity and population health. Most significantly, EMS may move from measuring individual ambulance encounters to measuring episodes of care.
That requires agencies to start building hospital relationships, data-sharing capabilities and quality infrastructure now. Response time will remain important, as will operational efficiency, resource availability and hospital turnaround. The mistake is allowing any single metric to become synonymous with quality.
Summarizing the discussion, Lawrence highlighted the inherent problem with judging EMS performance against an arbitrary response-time threshold. “An ambulance arriving in 8 minutes 59 seconds and the patient dies is considered a success, while arriving in 9 minutes and 1 second and the patient lives is considered a failure,” Lawrence said. “That’s messed up. We need to fix it.”
The point is not that response time no longer matters. It is that response time without clinical context tells only part of the story.
Attendees also pointed participants back to EMS Agenda 2050, arguing that many of the concepts discussed by the panel — integrated care, patient-centered outcomes, alternative models of delivery, data sharing and technology — were anticipated in the profession’s long-term vision years ago. The difference is that EMS increasingly has the technology and data infrastructure to make that vision achievable.
EMS has spent decades becoming exceptionally good at answering how fast did we get there and what did we do?
The next evolution of quality improvement requires answering a harder and far more consequential question:
What happened to the patient — and were they better off because EMS was there?
Additional resources:
- AIMHI webinar: Measuring (and improving) what matters
- Culture shift: Reducing lights and siren vehicle operation
- Educating the public about when it is appropriate to call EMS – and how quickly we should get there
| MORE: Response time addiction: Is EMS under an urgency illusion?
