Applying for QA/QI, need ideas

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PNWmedic767

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Hey guys!
My name is Joe, a fellow trauma junkie. I have recently been given to opportunity to apply for a QA/QI position at my current place of employment. We run 700-1000 calls a month and its a single man position. The reason the position is open is because the last guy kinda "failed" the position. The supervisors are opening the position back up but they aren't making it easy. There are two other medics that made it through along with me, next up is interviews. I'm not worried about the whole interview part of it, but they are throwing a curve ball at us. Since the last guy did not meet the standards they expected, they want all three of us to come up with presentations to show what are plans are if we were to get the position along with ideas on how we can make the position better. This has nothing to do with training since we already have a training officer, it's strictly QA/QI. I have already stated a majority of my ideas which were included in my letter of interest, but I need more ideas about how I could make the position better.

So here is the breakdown, the last guy was in charge of reviewing every code-3 transport, along with setting up a once monthly "case review", which was where our medical director went over usually 3-6 calls in depth and either gave kudos or criticism.

  • My plan is to attempt to meet the goal of still reading every code-3 call, along with every 3rd-5th chart submitted by each paramedic "code-1 or 3". With this I feel like I would be able to not only assure quality care with code-3 transports, but make sure code-1 transports are still getting the same quality of care.
  • Still continue the case reviews
  • A new idea would be a "interesting call of the week". This would be print out a call summary and black out all patient info, and let people see the treatments and such.
  • Start a "close call" program to where if a minor incident happens "wrong drug, wrong dose, undertreatment, mistreatment" keep it in a file, then be able to keep track of, if and when people mess up and be able to track trends and possibly recommend certain training to the employee to become better aware, or if its to the extent that multiple people are having the same problem, inform the training officer and see if he can come up with some sort of training.
  • One thing that I would specifically want to do is something that has been partially started but never made it far. We have access and contacts at our local Level 3 trauma center to follow up with our codes, code-stroke, trauma system entries and STEMI alerts, but if they are transferred out like they normally are with a level 3 trauma center we lose track of them and never be able to follow up. I would like to start up where I can keep track of them using there trauma band #'s, or patient ID #'s and help the crews see that what they did either benefitted the patient or not. This would just take making phone calls and getting ahold of trauma coordinators and others and setting up to where I would be able to contact them every week or month and get diagnosis/end outcome and such.
I need more ideas of things I could incorporate into this position that would make me good candidate!
If you all can think of anything or even think about your own companies and cool/interesting things the QA/QI does for you guys that you appreciate let me know. I am interested in this position to better improve patient care along with making it easier for the guys to see the actual good they do in the long run after they drop the patients off and move on to the next one.

Stay salty my friends and have a quite night.
Joe
 
Here are some examples, some of which you mentioned, but I'm just expanding on.

- Patient follow up. Try not to limit yourself to STEMI, Stroke and Trauma. We all know what a STEMI looks like, and we can all see that guy's arm is missing. How about that patient I brought in that I thought might have had a PE? Would be nice to be able to find out if I was right. Or how about the guy I treated for COPD, but maybe it was CHF? Would be nice to know for next time.

- Flagging for high risk/low frequency skills; in addition to looking at code 3 transports and "random" charts, also consider flagging charts that have high risk low frequency skills. These can be anything, and can even be revolving based on what your data shows needs monitoring. Are we having low first pass success with SGA? Let's monitor. This is also a great way to test new equitpment and evaluate if it can be used long term.


- Monthly/quarterly review on targeted skills. Along with the above, take one of those and make it a teaching point. We have quarterly inservices, but as you said you have a training officer. You could pass these objectives to him, or take a side approach; for example by every toilet we have the "Squatters Report" which is just a short update on best practices.

- Transparency in data. Allow crews access to the data. Let them know if CPAP is not being used successfully, or if ETI success is down. This can drive motivated employees to improve themselves and seek ways to ensure success.

- Case review. I like case review.

- QA/QI accessibility. Make sure the QA/QI officer is accessable for one-on-one review of a report. This doesn't have to be comprehensive, just ensure there is a pathway for direct feedback.

Most importantly make sure QA is EDUCATIONAL NOT PUNATIVE!
 
NPO covered almost everything I would have said. Using outcome data to help evaluate prehospital care is a growing practice and really important, I think. Also, QA/QI means closing the loop on quality improvements -- i.e., documenting favorable changes that result from all the reviewing you're doing.
 
Make sure that you reach out to the hospitals, fire departments, other EMS services, et cetera. They all (should) have QA departments, EMS liaisons, trauma registry, stroke coordinators, code committees, et cetera that you can network with to see what in your service or in the system as a whole are areas of improvement or when things are working well. Building that network is invaluable to improving your service.

I could tell you where our various local EMS agencies (and our HEMS/CCT group) shine and where they need to get better, and the more professional organizations want that feedback. I often submit cases for review for our EMS crews not because they did anything wrong but because the patient had an interesting or unexpected outcome and having that knowledge will only strengthen them as clinicians.
 
QA/QI is inherently training, but you're directing the training, not necessarily providing it. You need to find what needs work and focus on that. A big part of your job is to get training and administration the information they need to have to focus on those weak points.
 
I am going to try to focus on the high risk, low frequency calls. I have cricothyrotomy, needle decompression.... Any other ideas??
 
PNWmedic767 said:
I am going to try to focus on the high risk, low frequency calls. I have cricothyrotomy, needle decompression.... Any other ideas??
Click to expand...
Really any intubation outside of cardiac arrest (and even some of those) if you want to do it that way. Our case reviews are structured around calls in which some high acuity related intervention was performed. Which is fine, but becomes repetitive. Sometimes it's just good to go over cases where the provider's did a super solid job managing a pretty sick but maybe not crazy critical patient just to ensure that the baseline standards remain high.
 
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I'd love to see follow-ups on non-critical patients.
 
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