Internal Quality Improvement

For the last couple of months, the term Personal Responsibility has become one of my favorites.I think it’s the answer to many of the questions that we ask day in and day out not only on the streets as we take care of our patients, but in life in general.

I constantly struggle with how to provide effective QA/QI and where Chart Review falls into that whole mix.Now, I haven’t done a ton of Chart Review in my day, but I’ve read some truly bad ones, and I’m sure I’ve written my share of less than desirable charts in my day, but does it go without saying that a poorly written chart means substandard care was provided?I don’t think that is always the case.A strong argument could be made that the quality of the chart written can be a direct reflection of quality of care, just like the cleanliness and readiness of one’s ambulance could indicate the same, but ultimately, what is a Patient Care Report?

That PCR isn’t just the picture that we paint for those that we turn care over to, or those that review our charts in the Chart Review process.Ask yourself this: Do you think James Patterson, Stephen King, or your favorite author could write an effective chart?I’d say they could probably paint a pretty clear picture of what happened.Does that mean they have the patient care to back it up?Absolutely not.

Effective documentation shows a person’s ability to tell a story and craft words.Don’t let the term “Craft words” confuse you.I’m not saying that people are not truthful, because I have a lot of faith in the people that work in this field.I think that a majority of the time, what is documented is an accurate account of the call, but we need to start looking at patient care beyond the chart, and beyond the capacity that an English Professor, or a Math Teacher would look at it from.

How do we do that?Well, that’s the difficult question.When practicing medicine in the pre-hospital setting, we often act alone, in the back of an ambulance, or with one other knowledgeable person present to help us.Random visits on calls by Supervisors, Clinical Coordinators, or even Medical Directors are a great start, but we need to start looking for a more simplistic answer.This is where the concept of Personal Responsibility and Internal QA/QI comes in.

The first step in owning your own Quality Improvement is identifying your short comings.We all know that we have them, and it’s up to us to decide what to do with them.Do you struggle with 12 leads?Well, how do you respond to it?Do you get defensive?Do you welcome criticism?Do you try and blow it off or cover it up?Or do you practice, study, and try to improve?

Know the resources that are out there at your disposal.Know the knowledgeable street medics in your system, and know who is willing to help.Go see an old FTO, or a partner, or even a Clinical Coordinator.None of us knows everything, but we all have little pieces to offer.AttendPre-Hospital Morbidity and Mortality sessions, and even try and suggest some of your own personal cases to be reviewed.Then, just sit back and listen to what your peers have to say about them. Crack open that old medic text book, or review some old strips.

Ultimately, always be humble, open and receptive to what those around you have to say, and willing to learn.A sign of a good medic is one who says, “I really have no idea what was going on with that patient.”A sign of a great medic to me is one who follows that statement up with, “I’m going to go find out for myself.”

It’s all about taking responsibility for the quality of the care you provide.The only moment that is worse than the one where a person stops learning is the moment someone says, “I don’t need to know that.”