QA/QI – My Personal Journey

There are a lot of good clinically focused blogs out there on the Internet, and mine certainly isn’t one of them. That’s not to say that I don’t feel I’m a sound, clinical paramedic, because really I do, I just don’t write about the medical topics. “Being a provider” and the challenges that we face as an industry interest me more. I do, however, feel the need to talk a bit about Quality Assurance and Quality Improvement and what they mean to me.

I came from very humble, small EMS Beginnings. Growing up in Suburban New Jersey, most of the BLS 911 work was done solely by Volunteers. While my clinical experience was great, my knowledge that went into documentation and the feedback that I saw from it was almost non-existent. Although we would provide what I felt was excellent care, when we got to the Emergency Room, it seemed to me that the care started over. Run forms that were written were poorly written at best, some as short as one or two sentences that attempted to sum up the events that led to the patient landing in the ER.

Fast forward now a few years to my freshman year of college. I didn’t know any better from what I learned in New Jersey. I thought that was “the way” to write a run form. I participated for four years in our Campus EMS Department, and in my freshman year, our advisor brought in a Lawyer to review our run forms and let us know how we were doing. I’ll never forget it; mine was one of the ones that ended up on the overhead projector: “Patient fell during a flag football game and injured his ankle. Patient refused treatment.” That was it. Two sentences and I was done. There I sat, a young 19 year old EMT, raked across the coals by a lawyer pointing out all of the problems with documenting like this. I quickly learned my lesson, and put 100% into my documentation, both at college and at home in New Jersey.

Now, here I am, 13 years later, working in a busy urban system as a Supervisor and ten year Paramedic. We talk a lot about what Quality Assurance is in our system, and how it should work. Most people here seem to think that “Chart Review” means Quality Assurance, and I couldn’t disagree more. Is Chart Review a piece of the QA/QI puzzle? Absolutely, but standing a lone, it is more a measure of how well a provider crafts their words, not a measurement of the quality of care they are providing day in and day out.

With NEMSIS being a new focus, we have the potential to collect hundreds of data points from each and every call that we do. We can tell what population we are serving, we can measure the quality of timely care being provided based on IV success rates, time to intervention, and just about any other aspect of the job that we can think of, but again, that’s only a piece of the puzzle.

To me, Quality Assurance involves going out in the streets and actually seeing what people are doing. Observe how a code goes. Be willing to take a peak at that 12-lead lead placement. Double check the technique and equipment used to secure a tube.

Now, take a good hard look at what you do to help improve the care that is being provided. Critique, offer advice, and identify weak spots to be addressed in refreshers and updates. Each and every single one of us can identify some aspect of care where we fall just a little bit short. None of us are perfect, hence the need for that constant Quality Improvement push that we should crave.

Just remember, when each of us is sitting on the other end of the QA/QI process, we need to be humble and willing to accept constructive criticism. Be willing to learn from others, whether they have been doing this longer than you have or are brand new fresh out of class. That’s one of the reason I love working with new medics or students, they challenge me and have such fresh information in their heads that its almost like having a mini refresher when I work with them.

Finally, constantly conduct your own internal QA/QI, both in your head and in your truck. Greg Friese over at Everyday EMS Tips had a great one the other day, when he talked about reflecting on each call. What a great idea. Take a second or two to chat with your crew about what went right on the call and what can be improved on.

Most of all never lose that thirst for knowledge. Search for what makes you a better provider. Strengthen those weak spots, and try and learn something new on each and every shift. Remember, the people that you protect are counting on you!

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