Tell me about your QI.

[NomadicMedic]

I’m in a new position where I can make changes to the QI process. Tell me about your department.

Specifically, does your department embrace “just culture”? How often do you hear from QI? Do you only hear from someone when things need fixed? Do you self report errors? Are you comfortable self reporting? Does your department use QI as a vehicle for punitive action? Has your department moved from QA to QI? How many people review charts? Do you get praise from QI?

In short, tell me about it from a providers point of view.

What do you like, what do you dislike?

 

[DrParasite]

The QA/QI process has always been screwy where I worked. Either the QA was not done, was a joke, or was a waste of time.

I'm convince that it was not done at my first volunteer EMS agency. After seeing some of the poorly written charts by my colleagues (including the "officers"), I can only think that no one was ever reviewing any of the charts that were written.

at my first full time career EMS job, the on duty supervisor reviewed EVERY chart that was completed by the previous shift. This was a waste of time, because all he did was made sure there was a chart for every call, and all the mandatory boxes were filled out. He didn't check any content, only that something was there.

From an operational standpoint, the only time we heard from anyone in QA (which was handled by our clinical coordinator, one of the 4 people in EMS management) was if a complaint was filed by an outsider. If an internal complaint was filed, it may be investigated, or it might be swept under the carpet. Most of the time when QA was done, it was punitive. or it was ignored. a total joke.

when I worked in communications, the on duty supervisor reviewed 10 random calls every shift, which were handed to the coordinator, who filed them in the circular filing bin. If the supervisor found one that wasn't done right, he or she just went to another one. It was a total waste of time and paper.

QI should be used to make improvements, and to prevent problems from reoccuring. evaluating of documentation is one part, to ensure the documentation is done in accordance with agency desires. They should also go out in the field, and take notes on what is being done. All major calls should be reviewed. It shouldn't be punitively done (you did all these things wrong), but rather reviewed for good and bad. things can go well, but it needs to be objectively evaluated. The biggest suggestion I have is to get out from behind your desk. hop in the chief's SUV and go to calls, both major and minor. Bonus points if you can pick up the occasional shift on the ambulance. Some QA people end up always reviewing things from their desk, and forgetting what it's like to be a field provider in that environment.

 

[Carlos Danger]

Specifically, does your department embrace “just culture”?

I've never worked anywhere - 911, CCT, HEMS, or OR/ICU - where this was truly practiced. Some places payed some sort of lip-service to it, but I've never felt safe admitting mistakes.

Which is a real shame, because IMO, probably the best thing we can do to improve quality in healthcare is embrace this approach.

 

[StCEMT]

Despite many things I dislike about where I work, this area actually seems pretty decent. Random calls will be reviewed and a simple real sent back. All cardiac arrests are reviewed and I assume some other higher acuity things are as well. As far as the whole just culture thing goes, I haven't seen a bigger thing tested with it. I've self reported little things just as a CYA, but they were never anything that would have caused problems for the pt. So for now, it is at least spoken of, not sure how much is backed by action. I've never seen or personally had QI used punitively and I've talked to my Chief directly about these when I did them. I have no idea how many people review the charts, but there are a few people who look at stuff. For calls like arrests or actually any scene a sup shows up, we can expect some scene review. It had a lot of yes no questions with a summary by the sup. That can be a way to give details on where to improve, or just a summary + a kudos on a well ran call. Those I really like. It's something that can be reviewed at the end of the year for raises and stuff, but it also reaffirms how you and your partner work together and if your way of doing things is effective.

 

[DesertMedic66]

Our QA/QI department isn’t too bad. Our charts are not all reviewed. We have certain charts which are automatically reviewed and our CES will pull charts on calls where rarely used or high risk procedures are utilized and the same with medications.

We have 2 meets a year that all employees must attend that is usually taught by our CES department. Aside from that we really only hear from them is there is an issue. They are pretty good at getting follow ups on patients.

If I had an issue where I needed to self report then I would. So far I have only self reported for one call and that was for pain management admin for a multisystem trauma when I was unable to conact the hospital for orders (we have no radio failure policy/protocol). Haven’t heard anything back about it.

If there is a clinical issue then the employee will meet with the company medical director, county medical director, and CES and they will form a plan on what actions to take. It’s usually a pretty well established plan that offers the employees a lot of opportunities.

Really all I wish our CES department would do is give us feedback on calls aside from the ones that turned out bad and provide statistics to us.

I would be dreaming if we were provided with more than the bare minimum training education required to keep our medic license.