module eight special issues: quality assurance · special issues – quality assurance module eight...
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Module EightSpecial Issues:
Quality Assurance
Wisconsin EMS Medical Director’s Course
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Version 1.0 Wisconsin EMS Medial Director’s Course 2
Special Issues – Quality Assurance Module Eight
Objectives• Develop a better understanding of
Quality Assurance as it relates to EMS • Outline the nine steps of a
comprehensive QA program • Identify the role of the medical director
within a service QA program
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Version 1.0 Wisconsin EMS Medial Director’s Course 3
Special Issues – Quality Assurance Module Eight
What is Quality Assurance
• Quality Assurance (QA)o Process by which certain events are
selected and monitored as quality indicators
• Process allows for the gathering of information and datao Data protected for legal discovery
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Version 1.0 Wisconsin EMS Medial Director’s Course 4
Special Issues – Quality Assurance Module Eight
Quality Assurance
• Emergency physicians may have become acquainted with QAo Daily life in the Emergency
Department may have provided exposure
• Same concepts apply within the field of EMS
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Version 1.0 Wisconsin EMS Medial Director’s Course 5
Special Issues – Quality Assurance Module Eight
Quality Assurance & EMS
• Quality assurance is, at this time, generally unique to EMS units
• Several reasons whyo Costo Manpowero Philosophy
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Version 1.0 Wisconsin EMS Medial Director’s Course 6
Special Issues – Quality Assurance Module Eight
Quality Assurance & EMS
• Costo Process of QA requires time and
personnelBoth cost money and generally are not reimbursed
o Much of these monies are recovered through enhanced patient care and improved risk management
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Version 1.0 Wisconsin EMS Medial Director’s Course 7
Special Issues – Quality Assurance Module Eight
Quality Assurance & EMS
• Manpower o Commonly listed as a reason why
units do not have a QA program o Quite beneficial to have someone
familiar with the QA process to lead to team
o Often a team of individuals is developed in an effort to get multiple people involved
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Version 1.0 Wisconsin EMS Medial Director’s Course 8
Special Issues – Quality Assurance Module Eight
Quality Assurance & EMS
• Philosophy o Another barrier commonly listed o Philosophy that it
is not neededwill leave them open to more legal exposure will not improve patient care
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Version 1.0 Wisconsin EMS Medial Director’s Course 9
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan
• Assign Responsibility• Describe the scope of the service• Identify aspects of care that are
high-risk, frequent or problem prone
• Develop indicators and measurable components
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Version 1.0 Wisconsin EMS Medial Director’s Course 10
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan
• Collect and organize data• Analyze data• Create an action plan• Evaluate the effectiveness of
action• Communicate relevant information
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Version 1.0 Wisconsin EMS Medial Director’s Course 11
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan
• Assign Responsibility o Responsibility for the QA program
needs to be clearly identified Usually one individual is the head or lead QA personCommonly, multiple other individuals are involved and in some cases the entire unit has responsibilities
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Version 1.0 Wisconsin EMS Medial Director’s Course 12
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan
• Describe the scope of the serviceo QA program needs to be integrated
with the mission and vision of the unit
o Unit conceives a mission and vision statement in conjunction with a Quality Assurance program
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Version 1.0 Wisconsin EMS Medial Director’s Course 13
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan
• Identify aspects of care that are high-risk, frequent or problem prone o Team identifies those situations that
need review and are in need of evaluation
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Version 1.0 Wisconsin EMS Medial Director’s Course 14
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan
• Suggested QA projectso Deaths o No transports o Against medical adviceo Procedural complications
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Version 1.0 Wisconsin EMS Medial Director’s Course 15
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan• Suggested QA projects
o Track of personnel procedures and benchmark establishment
o Aspirin administration in chest paino Pain medication administration in long bone
traumao Pulse oximetry measurement in patients
with shortness of breatho Lung sound assessment in respiratory
distresso Documented Viagra screening in patients
receiving Nitroglycerin
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Version 1.0 Wisconsin EMS Medial Director’s Course 16
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan
• Develop indicators and measurable componentso Set benchmarks that actions will be
taken upon if data does not meet Intubations 95% after three attemptsASA in chest pain 95% cases without contraindicationsPulse oximetry 100% patients with CP/SOB or oxygen Rx
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Version 1.0 Wisconsin EMS Medial Director’s Course 17
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan
• Collect and organize datao Set a time frame for study; e.g. 3 monthso Set up a QA calendar
Outline QA projects for the year three months prior to new year
o Collect data for review by multiple segmentsPersonnelTime & Date of callMedical control
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Version 1.0 Wisconsin EMS Medial Director’s Course 18
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan
• Analyze datao Compare data against pre-established
benchmarkso Determine trends across several
segmentsDo personnel need additional training?Are there medical control education or performance issues?Does performance vary by time of day or day of week?
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Version 1.0 Wisconsin EMS Medial Director’s Course 19
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan
• Create an action plano Determine necessary fixes to correct
shortfallso Implement fixes and monitor
progress
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Version 1.0 Wisconsin EMS Medial Director’s Course 20
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan
• Evaluate the effectiveness of actiono Repeat study without changing
mechanisms, unannounced at a pre-determined interval after fix
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Version 1.0 Wisconsin EMS Medial Director’s Course 21
Special Issues – Quality Assurance Module Eight
Nine Steps to a QA Plan
• Communicate relevant informationo Keep personnel involved and
informed of the process o Do not keep QA a mysteryo Display information anonymously for
unit review o Review individual material in private
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Version 1.0 Wisconsin EMS Medial Director’s Course 22
Special Issues – Quality Assurance Module Eight
Example QA Study
• Topic: Viagra Screening in patients receiving Nitroglycerin
• Time-frame: Jan – Mar / 2002• Data: Review all charts that
list nitroglycerin being administered
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Version 1.0 Wisconsin EMS Medial Director’s Course 23
Special Issues – Quality Assurance Module Eight
Example QA Study
• List; personnel, day, time, medical control, vital signs, meds, allergies, complications and Viagra screening
• Compare data against pre-established benchmark –100%
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Version 1.0 Wisconsin EMS Medial Director’s Course 24
Special Issues – Quality Assurance Module Eight
Example QA Study
• Publish data and implement training: e.g. protocol review, medication review
• Repeat review –o Study: Jan – Mar / 2002o Data Review: Apr – Jun / 2002o Education Jul – Sep / 2002o Repeat study: Jan – Mar / 2003
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Version 1.0 Wisconsin EMS Medial Director’s Course 25
Special Issues – Quality Assurance Module Eight
Closure
• How does quality assurance relate to EMS?
• Nine steps of a comprehensive QA program
• Medical director’s role in a service QA program