EMS Innovations 2009: A Five-Part Series

Each February, the cutting edge of prehospital care comes to Dallas. The EMS State of the Sciences Conference, more commonly known as A Gathering of Eagles, brings together medical directors from EMS systems in the largest U.S. cities, plus various bright and important invited guests, to share ideas and innovations, debate current problems and recent developments, and generally chew the fat on all matters clinical, operational and social. This year's conference attendees--among them EMS providers, chiefs, directors, educators and researchers, as well as physicians, nurses and others--were treated to nearly 60 brief but chock-full presentations over just two days, including "lightning rounds" that brought the speakers together to tackle issues as a group.

Again this year, EMS Magazine followed up on a few of the most interesting presentations, soliciting additional thoughts from the docs behind them and presenting them here for your consideration. All are geared toward improving patient care and system function. Could they be adapted to your system? Read on and ponder.

Part 5: Reinventing Quality Improvement--How the Memphis Fire Department Survived "Middle Management Paralysis"

By J. Harold "Jim" Logan, BS, EMT-P/IC

The Memphis Fire Department's EMS Division began its quality journey when the state of Tennessee mandated "quality assurance" in 1992. Most state EMS services still use that era's outdated QA document, which includes templates of check boxes that would make most people's eyes bleed and fall out. The document is well intended, but does nothing in the way of improving patient care or service to the community. This type of "quality enhancement" tool was viewed by field providers as Big Brother looking over their shoulders and was seen as a punitive. It was a tool for assurance, not improvement.

With no direction or top-down support for this state mandate, the QI culture within the department was dismal to say the least. We could identify problems but had no effective mechanisms to improve them. Our system was dysfunctional, with no field supervision, no active education or training to help providers identified in the QA process, and no active medical direction.

Fast-forward to 2005. With new leadership in place, we reanalyzed and overhauled our service completely, including our quality improvement efforts. Under our new leadership, we established a robust EMS rank structure, increased our education staff and course offerings, and employed a full-time and very involved medical director. Quality improved rapidly in this new environment. Given his success with other organizations, consultant Mike Taigman was called in to consult on quality at the beginning of our restructuring, and he offered suggestions to provide better prehospital care and customer service. We employed several of his suggestions and instituted methodologies that improved trust between our QI team and field providers. Our medical director and quality improvement team began meeting with providers about trends and issues discovered in reviews of patient care reports. This was done nonpunitively, and gave providers good suggestions for improving their care and service. Our new vision and efforts let us work with our education department to incorporate education and training focused on trends found during chart and case reviews and system problems found by our officers in the field.

But while the service we were providing to our citizens seemed outwardly to be improving, the data to support our efforts was not as impressive. We were still missing a piece of the puzzle. So in 2008 we invited Taigman back for a checkup. We provided him with all the information related to the changes we' made, including quality peer review, a mentoring program for new employees, and monthly QI meetings with our EMS officers. We explained to him our dilemma: Our system had improved by leaps and bounds, but it appeared our patient care and protocol compliance had hit a wall, and improvement had reached a plateau. We asked Mike if there were other services we could look to for possible benchmarks.