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    Cqi for Ems: A Practical Manual for Quick Results
    Cqi for Ems: A Practical Manual for Quick Results
    Cqi for Ems: A Practical Manual for Quick Results
    Ebook114 pages1 hour

    Cqi for Ems: A Practical Manual for Quick Results

    By David Jaslow MD MPH FAAEM and Joseph Hayes III NREMP-P

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    About this ebook

    CQI for EMS is not just another long winded, academic dissertation which drones on about abstract theories borrowed from quality control of industry, rather it is a quick and easy read specifically designed for the beleaguered, time and resource challenged EMS quality coordinator. CQI for EMS is ten chapters of tried and proven initiatives which you can literally read one day and put into effect at your agency the next.
    LanguageEnglish
    PublisheriUniverse
    Release dateJul 28, 2011
    ISBN9781462026197
    Cqi for Ems: A Practical Manual for Quick Results
    Author

    David Jaslow MD MPH FAAEM

    Joseph Hayes III, NREMT-P has served in EMS for over thirty years. Joe is Deputy Chief of the Bucks County Rescue Squad in Bristol, PA. and a staff medic at Central Bucks Ambulance in Doylestown, PA. Joe serves as quality improvement coordinator at both agencies. In addition to authoring CQI for EMS, Joe writes Quality Corner, a monthly column on quality improvement for EMS World and is a frequent contributor of articles to EMS World magazine. Joe is also a member of the National Association of EMS Physicians, Quality Improvement Committee. Dr. Jaslow Bio David Jaslow, MD, MPH, FAAEM is an emergency medicine physician and serves as the Director for the Division of EMS and Disaster Medicine at Albert Einstein Medical Center in Philadelphia, PA. Dr. Jaslow is the Medical Director for Bucks County Rescue Squad in Bristol, PA and Bryn Athyn Fire Company, in Montgomery County, PA. Dr. Jaslow also serves as Medical Director for Pennsylvania Urban Search and Rescue Task Force I.

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      Book preview

      Cqi for Ems - David Jaslow MD MPH FAAEM

      Contents

      Acknowledgments

      Foreword

      10 Commandments

      of

      Quality EMS

      Chapter 1

      Chapter 2

      Chapter 3

      Chapter 4

      Chapter 5

      Chapter 6

      Chapter 7

      Chapter 8

      Chapter 9

      Chapter 10

      EPILOGUE

      Dedicated to all quality improvement coordinators

      past, present, and future

      who take on the glamorless, thankless,

      yet most important job in EMS

      Acknowledgments

      Scott Bahner, BS, NREMT-P

      Lawrence Brilliant, MD

      Barry Burton, DO, FACOEP, RN, EMT-P

      Kimberly Dicken, EMT-B

      Scott M. Henley, M.Ed., NREMT-P

      Anne Klimke, MD, MS

      Christine Landes, NREMT-P

      Ken Lavelle, MD, FACEP, NREMT-P

      Charles Pressler, EMT-P

      Layne Shore, EMT-P

      Christopher Sole, EMT-B

      Samuel Wargny, EMT-P

      Foreword

      This book is based on similar continuous quality improvement programs conducted at two midsized, third service EMS agencies in Bucks County, Pennsylvania.

      Thanks to the Bucks County Rescue Squad, located in Bristol, Pennsylvania, and Central Bucks Ambulance in Doylestown, a comparative study in quality improvement for EMS can be presented for the benefit of other EMS providers.

      When most people think of EMS, their thoughts immediately turn to LA County Fire Department, New York City EMS, or systems in other big cities. But 90 percent of all EMS agencies in the United States are small to medium sized. Consequently, they face constraints in organization, financial resources, and personnel, which make developing and managing a quality improvement program a challenge.

      Bucks County Rescue Squad and Central Bucks Ambulance cared enough about the quality of their patient care to take an objective look at what was going on at their agencies. They asked hard questions, made tough decisions, and broke with decades of tradition and precedent to do what had to be done to correct long-standing problems and deficiencies to dramatically improve the quality of their care.

      Anatomy, physiology, and pathophysiology are all the same whether the patient is in Bucks County, Pennsylvania, or Bogalusa, Louisiana, and so are most quality of care issues. For the most part, we all have the same problems. The only question is whether you’re aware you have these problems and whether you have a comprehensive process in place to resolve them or not.

      To date, very few books have been written on the subject of quality improvement for EMS. Those which have been, have typically been written at the academic level, are too long winded and drawn out, too focused on theory, and too steeped in the history of quality control in industry. These books were simply not tailored or well suited for EMS. While most of those books make a good case for the need to improve patient care, they are typically presented too abstractly to be of much practical use. And so the decision was made to write a book on quality improvement specifically designed for EMS, a how-to book that presents specific actions and ideas that have been tried and proven with reproducible results at the two aforementioned EMS agencies. CQI for EMS can literally be read one day and put into effect the next, with the potential for quick results in just days or weeks. CQI for EMS is not designed to be the last word in quality improvement, it is just designed to help get you started.

      Ken Lavelle, MD, FACEP, NREMT-P

      Medical Director, Central Bucks Ambulance

      10 Commandments

      of

      Quality EMS

      1. EMS is not just a job, it is a profession.

      2. Average, minimum, and mediocre are not good enough in EMS.

      3. Always remember, your patients are trusting you with their lives.

      4. Everyone gets to pick their primary care physician, but no one gets to pick their EMS provider.

      5. Remember, the S in EMS stands for service.

      6. You don’t win points by guessing right in EMS. You win points by maintaining a high index of suspicion, finding problems that aren’t so obvious, and always erring on the side of caution.

      7. There are no excuses in EMS. You either get the job done or you don’t.

      8. In most cases, patients will be more appreciative of how you treat them than the treatments you give to them.

      9. EMS is the first hour of medicine in the first thirty minutes.

      10. Always treat your patients the way you’d want EMS to treat you or your family.

      Chapter 1

      *****

      Quality in EMS: A History of Failure

      Failure is not falling down, it’s staying there.

      —Benjamin Franklin

      EMS is not industry: No book on the subject of quality improvement would be complete without mentioning W. Edward Deming and Malcolm Baldrige. So there you go—they’ve been mentioned.

      Unlike other books written on quality improvement in EMS, we do not intend to waste your time on theory borrowed from industry and suggest you try to apply those abstracts to EMS. Rather, what we will attempt to do is keep this as short, sweet, and to the point as possible with some pertinent and usable background information. In the end, we hope to arm you with enough basic knowledge and tools to initiate a quality improvement program that will quickly and dramatically begin to improve your agency’s quality of patient care, save lives, reduce risk, and make you, the quality improvement coordinator, look like a genius in the process.

      The challenge of instilling quality in EMS has been around for as long as modern-day EMS. Any EMS veteran will recall initiatives such as Quality Assurance, Total Quality Management, Continuous Performance Improvement, and now, the latest catchphrase, Continuous Quality Improvement (CQI). It’s like a tenement that catches fire and burns every few years; as soon as they rebuild it, they change the name in an attempt to erase the memory of the failure. So it has been with many quality programs in EMS.

      Despite the lack of theory and history of quality in industry presented here, it might be useful to review the history of failed quality programs in EMS to give you some background and understanding of the scope of the problem.

      Educational deficit: Let’s start at the beginning, with the education deficit. Doctors complete four years of college, go on to four years of medical school, and then spend an additional three or four years in internship and residency. This is where they begin to practice medicine under the watchful eye of an experienced, senior physician. These mentors teach them the practical application of medicine, review their diagnoses, and sign off on their treatment—for three or four years, mind you. Nurses take two to four years of college and have their own clinical internship, where teaching nurses mentor them in a similar way as physicians. It’s worth noting that despite all of their education and training, nurses are fairly restricted in their application of medicine; it’s always under the direction of a doctor (with the exception of advanced practice nurses such as nurse practitioners).

      Then you have the medics. For all intents and purposes, paramedics practice physician-level medicine, though much more limited and focused in scope. But compared to the educational requirements of a physician or nurse, most paramedics on the street today complete between twelve and eighteen months of training. Back when I became a medic in the 1980s, we were referred to as nine-month medical wonders… among other things, due to the fact that we learned all our emergency medicine in that very abbreviated amount of time.

      After completing the paramedic course, a new medic typically does a preceptorship, which typically lasts from three to six months. This is where the new medic is mentored by a senior medic, who is typically a product of the same express line system of emergency medicine, after which the new medic is turned loose on society. Using myself as an example, I finished my nine months of medic school, completed a three-month preceptorship, and then spent the next twenty years repetitiously doing what little I was trained to do.

      In twenty years, I received exactly five letters of inquiry from the quality assurance committee. Twenty years, thousands of patients, and just five questions asked.

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