Quality Corner: Part 1--Introducing the Quality Corner

There aren't a lot of resources available for EMS QI folks. Here's one.

Lots of people, when they think of EMS, imagine large systems like the Los Angeles County Fire Department or FDNY EMS. In reality, 90% of EMS agencies in the United States are small to medium sized. In many instances these smaller agencies and systems fight constant financial and resource challenges. They frequently have no budget or extra personnel to manage quality improvement programs. In many instances their quality coordinators end up performing double duty, doing that job between calls or on their own time, without compensation.

Further complicating the issue is that too often, people are appointed to quality coordinator positions for all the wrong reasons: time in service (as if just showing up for 20 years imparts some magical wisdom!), light duty, punishment or even gross incompetence in their practice of paramedicine. I know of a provider who was pulled off the street and made quality coordinator after attempting to administer nitroglycerin to a patient complaining of chest pain. The patient had driven into a bridge abutment and demolished the steering wheel with his chest.

Hospitals and other healthcare institutions have the Joint Commission (formerly JCAHO), which specifically looks at quality indicators. EMS agencies are typically licensed for service based on equipment and medical supplies in their ambulances, as if inventory were the final determining factor in patient care. Even at this late date in history, there is no national quality care oversight authority for EMS. Depending on the state, the function of quality improvement is delegated to regions or counties or, in many cases, left to individual agencies policing themselves. Consequently, we're left with a patchwork of varying standards of care from community to community, agency to agency and even provider to provider. By definition, that's no standard at all.

While some states and regions may be more progressive than others, there are generally few resources for quality coordinators in EMS, especially those in small to medium-size systems with tight or no budgets for such things. Courses on QI are few and far between. Those that do exist are offered sporadically and in limited locations. In many cases the total extent of training for a new quality coordinator is spending an hour to a day with the old coordinator. All that teaches them is the same old way of doing things. For new quality coordinators industrious enough to want to buy a book on the subject, the few out there are primarily written by physicians and academics and targeted more for medical directors than quality coordinators. They are voluminous and verbose and typically regurgitate the same old theories borrowed from the quality control programs of industry. I read several of these books while developing my quality improvement program, in hopes of gleaning some ideas. In my humble opinion, they translate poorly to the unique world of EMS and offer little to nothing as far as how to actually develop or manage a quality improvement program.

With so few resources available, it has been pretty much left up to individual EMS agencies to figure out how to improve the quality of their patient care. This has resulted in colossal expenditures of time and duplications of efforts, with results limited to the experiences and ingenuity of each agency.

As a leader in emergency medical services, EMS World recognizes that quality improvement is the core business of EMS. This column will serve as a forum where concepts in quality improvement can be shared. It will appear monthly. In addition, EMS World will also inaugurate the Quality Corner Message Board, which will be up and available 24/7. This will be a professional networking forum where any quality coordinator can post questions, offer suggestions or comments, or share ideas with their peers. Quality coordinators trying to improve your agencies' standard of care with little or no help, you are no longer alone.

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