QI can be heartbreaking

[DrParasite]

How aggressive should we be with QI and when does poor performance become a termination offense rather than just remediation. And does anyone think a remediation plan will actually work? (Most of us say no)

honestly, I think aggressive QI should be the norm, rather than the exception. Give people a lot of freedom to practice medicine, using evidence based concept, but follow up and ensure they can defend their actions. And I also think it's unfair to terminate someone without even attempting a remediation. Especially, if you have never even discussed the issue with the person. That's just my $0.02.

Yes, some people are not cut out for this field (or should have been fired years ago, but for some unknown reason, they still have a job), but we still need to at least try to make people better. QI is not intended to be a punitive process; otherwise, people end up either covering up their mistakes in their documentation, or QI/supervisors don't want to actually find bad things because they will cost someone their job (both of which are unacceptable).

Do I think a remediation plan will work? Don't know, but likely not; however, that doesn't mean you shouldn't at least attempt it, especially if this was an isolated disaster.... after all, people can surprise you and turn themselves around.

BTW, if you do fire the guy, he or she is going to get another paramedic job. Unless you go to the state and request that they yank his cert, you're just passing the bad penny onto someone else, and the cycle will repeat with no actual fixing of the problem.

 

[NomadicMedic]

honestly, I think aggressive QI should be the norm, rather than the exception. Give people a lot of freedom to practice medicine, using evidence based concept, but follow up and ensure they can defend their actions. And I also think it's unfair to terminate someone without even attempting a remediation. Especially, if you have never even discussed the issue with the person. That's just my $0.02.

Yes, some people are not cut out for this field (or should have been fired years ago, but for some unknown reason, they still have a job), but we still need to at least try to make people better. QI is not intended to be a punitive process; otherwise, people end up either covering up their mistakes in their documentation, or QI/supervisors don't want to actually find bad things because they will cost someone their job (both of which are unacceptable).

Do I think a remediation plan will work? Don't know, but likely not; however, that doesn't mean you shouldn't at least attempt it, especially if this was an isolated disaster.... after all, people can surprise you and turn themselves around.

BTW, if you do fire the guy, he or she is going to get another paramedic job. Unless you go to the state and request that they yank his cert, you're just passing the bad penny onto someone else, and the cycle will repeat with no actual fixing of the problem.

Agreed, which is why I'd have the Medical Director pull his command authorization.

 

[FiremanMike]

My favorite line during QI/debrief

"Why can't you just thank us for taking her to the hospital"

 

[Carlos Danger]

Cardiac arrest management is very objective and algorithmic. So much that I don't really know how someone can seriously mismanage one unless they just don't know the protocols the way they should, or suck at rhythm interpretation. There's typically little in the way of judgment involved.

Is this a case of the person just not knowing the protocols? As in a newer medic who never learned them as well as they should have, or an older medic who hasn't kept up with changes and needs a thorough review? Is performance anxiety causing difficulty with recall during the call?

 

[MetroMedic94]

If the provider cannot make good, critical decisions, can they continue to work as a paramedic?

I think it all depends on the experience, time in service and the training provided. You can have a first year medic outperform a 20 year veteran and vice versa. Some institutions pump out barely competent paramedic and others make fine entry level ones. In my personal experience, I have an average program that taught off extremely restricted protocols. When I did my internship in another county, they had an open scope of practice where I learned a lot of medicine. Fast forward to day, I'm a decent (I use that term loosely) medic who passes QI without major strikes. My buddy from paramedic school is still in the same county and hasn't ran a single critical call as he's rural fire based with the same restricted scope of practice. He struggled quite a bit when he came part time to the service I worked at.

So I really believe is a combination of things. Everybody can make a good paramedic if they have the determination to be one. QI is meant to keep us in check and expose our weaknesses in a constructive manner. I would by lying if I said some people cannot be helped, but then again it all goes back to determination.