EMS Quality Management Program

Michael D. Curtis, MD, FACEP

EMS Medical Director

Medical Direction Triad

Quality Management

Training Protocols

Five Major Components

QA CQI After Action Reviews RSI Cardiac Arrest (Other?)

Quality Management Policies

All documents are confidential and include language on them about confidentiality

We do not discuss specific contents of confidential quality management activities in public meetings or with our oversight boards and committees

Participants in quality management activities are required to maintain confidentiality

Quality Assurance

Retrospective review of a single case Used in problem cases To monitor new protocols or procedures

(e.g., Ketamine use) Used in educational case reviews

– Access to records

Standard Form

QA Form

Microsoft Word Document

CQI

Using descriptive statistics to assess performance on 19 quality indicators over three patient scenarios

Scenarios:– Cardiac Chest Pain– Respiratory Distress– ALOC

In development: Major Trauma

Eight Services Involved

Portage County – SPFD Portage County – AFD United Ambulance Service Wisconsin Rapids Fire Department Merrill Fire Department Schofield Fire Department Weston Fire Department Rothschild Fire Department

CQI Quality Indicators

Vitals Signs – Complete Vital Signs < 15 minutes Vital Signs – Repeat Oxygen Lung Sounds Cardiac Monitor IV Attempted IV Success Rate IV SOFA

IV Established ALS Intercept Glucose Check (ALOC) Nebulizer (RD) CPAP (RD) Aspirin (CCP) 12-Lead EKG (CCP) STEMI Scene Time

<20min (CCP)

Example of Score Card

Microsoft Excel Worksheet

After Action Reviews

Major Incidents Multiple Patients Multiple Agencies Responding

After Action Reviews

Meeting place People included Confidentiality Recording

After Action Review Form

Microsoft Word Document

The Challenge

Once you identify your problems or flaws, what can you do to fix them and prevent them from occurring repeatedly?– Focus on individual performance?– Focus on department-wide education?– Focus on standardizing work processes?

How can we learn from each other at the leadership level to better manage quality improvement?

Questions?