How many of your charts get audited?

Fox800

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What percentage of your charts get audited for QA/QI?

At my last job, at least one out of every 25 charts you did had to be audited by the clinical department, per policy. Also, any advanced airway, cardiac arrest, STEMI, stroke, or air medical call automatically got QA'd. You'd get it back in about 3-4 days, with the report picked apart and suggestions for improvement.

At my current job, we don't hear anything unless you screw up. Apparently every arrest/stoke/STEMI call gets audited, but we receive zero feedback unless something goes seriously wrong. I've only had three charts audited in the two years that I've been here, and one of them was because I asked about it.

Who audits them, a clinical supervisor, your direct (immediate) supervisor, or a physician?
 

DrParasite

The fire extinguisher is not just for show
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reviewed by someone? in theory every chart.

actually QAed? like picked apart? probably 0.0000001%, based on the horrible documentation from my coworkers. and when I try to educate them, the response is "well, no one ever said anything, so I assumed I was fine."

ALS has more charts that get QA, but on a BLS level, it's a joke.

and of course, once someone files a complaint, then it's a full review.

Personally, I would be happy if the on duty supervisor reviewed the charts from the previous shift make sure the information was in the right place. But when it comes to proper documentation, it isn't even in the top 10 of our department's priorities.
 
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MrBrown

Forum Deputy Chief
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We still have regional level audits of paper based patient report forms so its a bit hit and miss.

QA is one of my pet subjects but I think its very difficult to build an accurate impression of care, or more importantly substandard care, from a brief history and some sets of vital signs on a piece of paper.

The Ambulance Service does engage ED staff in a feedback cycle to identify improvements that can be made and I think they do this on a monthly basis.
 

mar7967

Forum Crew Member
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we use electronic charts. Every chart is QA'd from a billing standpoint to make sure it is completely filled in, the address/zip code match, etc. After that, a few ALS and a few BLS providers QA everything else. I probably get comments on 10-15% of my charts.
 

MMiz

I put the M in EMTLife
Community Leader
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As a BLS provider 10% of my non-emergent calls went before the QA board, and 100% of my 911 response calls went before the board. Billing was a whole separate monster.

The QA board would make suggestions regarding treatment and transport. Billing would just leave 100 sticky notes on my runs, and expect me to remember the call from two months prior.
 

medicdan

Forum Deputy Chief
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As a clinical supervisor at my small department, I read and audit 100% of our reports, and bring them to our medical director, who reads 100% of the PCRs. I take her advice and feedback back to the staff. It's really quite a nice system.
 

Smash

Forum Asst. Chief
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Immediate supervisor audits 100% of run reports. QA/QI audits all cardiac arrests, drug assisted intubations, chest decompressions, cricothyrotomies and various sentinel events like death in care of medics or re-attendances at the same address within a certain time frame and various other things.
Our medical directors also review all drug assisted intubations. Feedback is both to individuals personally for any 'issues' and in quarterly publication that discusses trends and any areas that are percieved as being a systemic problem.
 

Flight-LP

Forum Deputy Chief
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Flight - 100% QA/QI by a dedicated QA/QI manager. Monthly random chart reveiws by one of the Medical Directors during our base meeting.

Ground Private - I as the Clinical Director review a 10% random sample of charts and perform 100% documentation and clinical QA on all CCT/SCT calls, in addition to all calls for employees within their initial 90 day probation. QI benchmarks tracked include pain management, advanced airway management (Intubations, PAI's, surgical crics / trachs), IV success rates (peripheral and central), and overall time on task details.
 

usafmedic45

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In the case of the last ground service I worked for all charts were reviewed by a supervisor. A certain percentage of all calls (5%, excluding the cases included below) were subject to random review by a QA/QI officer (such as myself; basically the top tier of supervisors who answered directly and only to the medical director). The following circumstances automatically caused a case to be reviewed by the QA/QI officer and then the medical director:
-Intubation, central line, IO, surgical airway or needle decompression.
-Use of the "protocol exception" protocol (yes, there was a protocol for violating the protocols in extreme circumstances)
-Multisystem trauma with abnormal vital signs or changes in mental status
-Aeromedical transport (which would get you put on administrative leave until it was determined whether you had made the right call; think of it as the EMS equivalent of the aftermath of a police action shooting)
-Administration of narcotics, benzodiazepines, paralytics,
-Cardiac or respiratory arrest
-Cardiac dysrhythmia requiring medical intervention (medication, defib, cardioversion, pacing, CSM, etc)
-Seizures
-Fever greater than 103 F
-Hypertension with end organ (cardiac, neuro, etc) symptoms
-Drug overdose, known or suspected
-Acute coronary syndrome
-Cerebrovascular accident, known or suspected
-Any case resulting in death within twenty-four to forty-eight hours of hospital admission
-Any case where any member of the system asks for review of the treatment, etc
(NOTE: I think I missed a couple but I am tired and it's been a long day)

IV and intubation success rates were tracked on a system wide, service wide and individual basis.
 
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ffemt8978

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We make it a point to audit at least one report from each provider twice a year, in addition to all arrests, trauma alerts, and drug administrations. In addition, our EMS administrator and EMS Training Officer will pull selected reports if they feel that something can be learned from them.

Given that we run about 300-400 calls per year with 20 providers, it averages out to be about 10% or so.
 

Dominion

Forum Asst. Chief
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Every run we write is turned it. From ALS full arrests down to BLS transfers. EVERY run gets reviewed. If it's off or you are missing things you receive a written notice with a copy of the run for editing. If it's flagged for QA you have to explain why you did what you did (or didn't do) on the QA form.

Our system is 100% audited.
 

thegreypilgrim

Forum Asst. Chief
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Somewhere between "none" and "negative infinity".

There is no formal QA/QI program either at my specific service, nor is there an independent system-wide one operated through our LEMSA. Each individual agency is responsible for it's own QA/QI and mine simply pretends that doesn't exist.

I swear I could turn in a PCR with a stick-figure rendition of what occurred on the call or just write "Pt Fall Down Go Boom" and I would literally never hear anything about it.
 

DrankTheKoolaid

Forum Deputy Chief
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re

100% chart QA for every provider at any level

Chart narrative grammar / spelling
Protocol adherence
Appropriate assessment Als/Bls care

Still establishing a true effective CQI program
 

EMTinNEPA

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The service I work for or the service I do my internship at?

The service I work for QAs only for billing. I could write that I treated somebody's stubbed toe with rapid cyanide injection into his eyeball and as long as I had at least one billable mile and insurance information, it would be fine.

As for the service I do my internship at, there are four stations and each one QAs another's charts. Each and every single chart gets peer-QA'd. In addition, all sedation-assisted intubation charts are QA'd by peers, management, the medical director, and the regional medical director. They are also working on a CQI program for STEMI alerts.
 
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