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Amy Gutman MD Tobey Emergency Associates EMS Medical Director prehospitalmd@gmail.com

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Review concepts & reasoning behind CQI & chart review Discuss benchmarks Key Performance Indicators Review common trip-ups in chart reviews Consider differences between not done & not charted Show you how to implement a basic CQI Process in your Agency EMS Quality Improvement Plan (EQuIPt)

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Theory-based, data-driven management system that looks at processes & outcomes to improve X Tools to quantify what we do Search for common causes of variation Shared success / failures Long-term approach Process & culture change

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Flexibility to meet need changes & refine service delivery processes Enhances information management, data tracking & documentation Determine & track program integrity & effectiveness Promotes data-driven & innovative solutions

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Accountability Input from all stakeholders Continuous progress review Adaptability

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Guide quality operations Ensure safe environment & high quality of services Meet external standards & regulations Assist agency to meet goals & objectives Benchmarking success

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Comprehensive quality improvement process include retrospective, concurrent & prospective Retrospective Review of PCRs after the fact Concurrent Real-time evaluation of pt care Prospective Anything to improve pt care quality prior to call being dispatched

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After (retro) & look or see (spective) PCR reviews most commonly performed aspect of QI Reviewing PCRs is tedious but necessary to gauge patient care Indirect benefit to a medical retrospective review is the opportunity to assess documentation for legal & billing purposes

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Goals Where Agency aims to be Objectives Specific plans on how to achieve goals Key Performance Indicators (KPIs) Quantifiably measure success of an objective that measure if goal was accomplished

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Leadership: Administration leads by example integrating QI into strategic planning process & entire organization. Strategic Quality Planning: Developing long & short-term objectives for structural, performance & outcome quality standards, identifying ways to achieve objectives, & measuring system effectiveness Human Resource Development and Management: Developing full potential of the EMS workforce guided by principle that providers are motivated to achieve high levels of service & value EMS Process Management: Creation & maintenance of high quality services via improvement of work activities & flow across functional or department boundaries EMS System Results: Assessing quality results achieved ;examining Agencys success at quality improvement Stakeholder Satisfaction: Ensuring satisfaction by those internal & external to EMS system with services provided Information & Analysis: Managing & utilizing QI information & data analysis

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Plan: Identify problem Do: Identify possible solution Study: Determine if solution improves or worsens problem Act: Implement possible solution(s)

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Elapsed Times Scene Time by Incident Peripheral Access Advanced Airway Critical Trauma Unconscious / Unresponsive Cardiopulmonary Arrest Suspected ACS Suspected Stroke Unstable hemodynamics including GCS

SSX c/w ischemia plus >1mm ST elevation in 2 contiguous leads or new LBBB ASA unless c/i or ingestion w/i 90 mins ECG w/appropriate, training-based interpretation by EMT-P & transmission to an EM MD / cardiologist Direct transport to a PCI center with protocol to activate cath lab team prior to EMS arrival Elapsed time from ECG acquisition to balloon inflation