Developing a Comprehensive QA Program (Connect 2016) - David A. Miles, Ph.D. (2)
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Transcript of Developing a Comprehensive QA Program (Connect 2016) - David A. Miles, Ph.D. (2)
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Developing a Comprehensive QA ProgramDavid A. Miles, Ph.D.
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Welcome!Thank you for choosing to attend this session!
Together in this hour we will accomplish the following items:• Give you some examples and tools that you can use to develop a QA program
in your organization • Review how our organization began developing a comprehensive QA
program• Look at pitfalls and items to avoid so you can learn from some of our
mistakes• Answer any questions and exchange great ideas
HAVE SOME FUN!!!
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“If learning isn’t fun,
you’re doing it wrong!”
Gary J. Confessore, Ed.D.
Professor Emeritus
The George Washington University
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Format for the Session…
• Case Study
• Interactive
• Q&A at the end
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Tell me a little bit about you?What type of EMS organization do you represent?
What role do you fill in that organizations?
What would be most helpful for you in today’s presentation?
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Our QA Journey…• Previously hit or miss…
• Not systematic
• Not process oriented
• Chiefly complaint or issue driven with some periodic random QA
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First things First…
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Documentation Guidelines Served as “Standard Work” for Crews to utilize for their documentation.
…also “standard work” for those doing the QA as a guide
• Format:• Began with the very first tab in FieldBridge and went step-by-step with what to
place in what box• Simple for the new employee to use and follow• Choices based on our agency
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Started with the “Why”
Stress to our EMS providers WHY our documentation was so important
Ultimate Goal for Program…
Improved Clinical Outcomes
Documentation Guidelines
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Documentation Guidelines• Step-by-step through the “tabs”• Covered the Narrative Portion separately • Examples at the end of the document
• Specific Reporting Requirements • Vents, medication drips, equipment, etc.
• Many involved in the process of creating the guidelines• Field providers, Supervisors / Field Training Officers, Managers• Billing Department
• Heavily influenced by…• Info from Page, Wolfberg, & Worth • The Missing Protocol: A Legally Defensible Report (1999 - Denise Graham )
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What did we want to accomplish?• Improved Clinical Outcomes / Patient Care
• Improved Clinical Documentation • Legal and Billing
• Compliance with State QA Guidelines• West Virginia• Maryland• Virginia
• ONE PROCESS (not three)
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Process that we developed
What was the process?
…what do you mean you can’t read all of that from the back row?
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Let’s take a closer look…
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QA Process
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QA Process
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QA Process
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Implementation (behind the scenes)• QA “auditors” identified
• Field Training Officers & Field Supervisors
• Process to capture and distribute information• Report Writer 2.0
• Could have entitled the session “How to build a QA process while not knowing ANYTHING about the QA/QI module in ImageTrend”
• QA Spreadsheet on our internal SharePoint Site• Created a site within our corporate SharePoint for the FTO’s/Supervisors specific to QA• HIPPA Compliant – no access to site from crews, etc. • All with access have signed ImageTrend Confidentiality Agreement
• Tools for Auditors• Fillable PDF form for auditing run sheets
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Standardize as much as possible• Reports ran every week on Monday
• Monday through Sunday of previous week
• Know where to go to find their weekly assignment• SharePoint site via Spreadsheet• No more than 5 QA audits per week per person
• Standardize• Forms (QA Audit Form)• Naming convention for saving work
• Training for all auditors • One-day initial training• On-going coaching by Referral Auditors
Implementation
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QA Audit Review Form
Everything in-between goes step-by-step through the PDF PCR
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QA Audit Review Form (First Page)
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QA Audit Review Form (First Page)
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QA Audit Review Form (Last Page)
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QA Audit Review Form (Last Page)
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Reports that we run
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Reports that we run
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Reports that we run
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Reports that we run
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Disseminating the Weekly QA (OLD)
Original configuration with only 2 FTO’s doing QA
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Disseminating the Weekly QA (OLD)
Once we added multiple FTO’s and Supervisors doing QA
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Prepare to be OVERWHELMED!
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Disseminating the Weekly QA (NEW)
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Disseminating the Weekly QA (NEW)
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BIG Lesson: Divide out the work
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Addition of Referral Auditors
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Addition of Referral Auditors
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Addition of Referral Auditors
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Tracking ComplianceTHREE MAIN FUNCTIONS for Referral Auditors:
Follows up with Field Staff on QA notes that they were copied on…
Randomly reviews the QA audits to ensure quality and provide feedback (i.e.: especially those with no QA notes to providers… ever)
Tracks delinquent QA audits
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Results?
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Results?
By tracking the problem we saw a DRAMATIC improvement in number of QA notes sent for inadequate Narratives
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Now where are we in the process…Status Post: ICD-10 (Looking to revamp our Documentation Guidelines)
Shuffle the deck with our Referral Auditors (experts, leaders, role-models)
Adding new FTO’s
New training and processes starting with Referral Auditors
New 1 day training for all
Start looking to improve again
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Lessons Learned…• WOW – it sure would be nice to know how to
REALLY utilize the automatic reporting and features in the QA/QI Module• Planning is great but…• Implementation can be rough - EXPECT
resistance from ALL parties involved• “I’m NOT using the CHART format, sir!”
• Time Consuming behind the scenes• The more buy-in from QA officers beforehand
the better• Keep plugging away at it… it does get better.
HINT!!!!
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Q & A…
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Remember… always give credit where credit is due!