Decreasing Usage of Lights and Sirens in an Urban Environment: A Quality Improvement Project

Abstract

Introduction: The risk of lights and sirens use in emergency medical services has been well documented. Our critical care transport team performs over 1,800 interfacility nonemergency medical services transports annually into a dense urban environment. Historically, we have utilized lights and sirens to navigate traffic patterns. The use exceeded industry standards. This quality improvement project was undertaken to decrease the use of lights and sirens.

Methods/results: The baseline use of lights and sirens in 2011 was 76% en route and 73% on return to the facility. We revised the internal policy guiding the appropriate usage of lights and sirens. In 2012, without an improvement in usage, a use justification process was implemented. By 2013, the use of lights and sirens was still high en route, but had decreased to 53% on the return trip. In 2014, we added accountability measures requiring justification, with a subsequent drop in 2015 to 14% en route and 13% on return. In the following 3 years, the transport teams have sustained lights and sirens use to 20% or below.

Conclusions: This quality improvement initiative impacted team behavior and decreased the use of lights and sirens over 5 years, with sustained improvement at or below 20%. This improvement was accomplished through ongoing evaluation, education, data gathering, and open communication. There was no negative impact on patient outcomes during this time. Lights and sirens continue to be used when indicated.

Fig. 1.

Use of Lights and Sirens 2011–2018. This graph includes the total number of transports, the total number of times lights and sirens were used (%) en route to the patient at the referring hospital, and the total number of times lights and sirens were used (%) during the return to the receiving hospital.

Fig. 2.

Percent Usage of Lights and Sirens 2011–2018. Multifaceted approaches to the improvement project began in 2011. Baseline use was 73%–76%. By 2013, there was a 20% improvement in use on the return trip. The following year with the request for the rationale for use statement, use dropped to 20% or less over the next five years. During this time, the transport team realized a 2% growth in volume annually. In 2014, as the use of lights and sirens most dramatically decreased, transport volume also increased most dramatically 9%–12%.