This is tenth in a series of articles from MONOC Mobile Health Services, New Jersey's largest provider of EMS and medical transportation and first CAAS-accredited agency. The goal of this series is to provide insight and solutions for the different managerial and operational challenges facing the EMS leaders of tomorrow. For more, see www.monoc.org.
Quality assurance (QA), an organized method of auditing and evaluating care provided within an EMS system, is the bane of any EMS field staffer. Since field staffers already believe they are treating their patients appropriately, why do we have to do quality assurance on them?
Setting the Parameters
As EMS managers, we must be able to document the fact that we do treat patients appropriately and within every guideline or protocol our system uses. So how do we go about this in a meaningful and productive manner? First, we have to set up parameters on how QA will be performed. Will we review only a percentage of patient care reports and all specialty charts like cardiac arrests or traumas? Or do we have the capability to perform 100% chart review and gather all of the information from our patient care reports? Once we decide how many charts we will QA, we then have to determine what operational or treatment parameters will be measured.
Will we look at out-of-chute times compared with national benchmarks, or measure response times or other data the service has decided on? How about clinical treatment protocols and how well we treat our patients? These are just some of the areas that can be considered when developing your QA system. Once these parameters are determined, you will need to enter them into a data base in order to capture this useful information.
Next, you will need to determine how you will deal with staffers who violate protocols or fall outside your specific measurement requirements, and how you will inform them of these problems. Will you take a one-size-fits-all approach or a stepped approach with different levels of quality assurance notifications? No matter what the violation is in the clinical realm, you will need to remediate the offender rather than use disciplinary actions.
If you adopt a stepped approach, you will need to determine how you will use it. What will constitute a minor violation where the staffer will receive a "coaching"-type memo, bringing to his attention the violation in a soft remediation tone? An example could be violation of an operational protocol that does not involve patient care and treatment. How will you deal with a one-time protocol violation? This could be a general QA "hit" where the staffer is notified of his or her offense and a record is kept of the breach of protocol.
What type of violation will call for a sterner tactic, like an administrative counseling memo that goes in the staffer's personnel file? This could be a severe variant of a patient treatment protocol or multiple QA issues of which the staffer has been notified and does not seem to understand the significance of the issue. This should be used in conjunction with a meeting with the staffer to help him understand the significance of the issues and that he will be under greater scrutiny during patient care.
What if none of these approaches seem to get the staffer's attention? You must have the ability to place that person on clinical probation status. Remember, for clinical issues we want to remediate our staffers, not discipline them. Sometimes, however, these issues are not patient treatment problems, but employee behavioral problems. Placing them on clinical probation means they will work under more stringent parameters and require even more scrutiny of their treatment of patients and adherence to operational protocols. Only after you have reached this step and the staffer still fails to adhere to the protocols can you consider disciplinary action or termination
Managing the Information