How to improve EMS quality assurance internally.

I’ve gone over why I initially didn’t like receiving updates on my patient outcomes in a past blog. Short story of it is I didn’t like receiving bad news about my patients after I had delivered them to the ER. I wrote more about it here: Why I avoided patient outcomes.

I learned during my career that there can be some very significant benefits to knowing patient outcomes. I have seen many different types of QA/QI and CQI being implemented and think all of them could benefit from something very simple being added to every emergency run: tell the ambulance crew the patient outcome post ER stay. After every call. After every patient. Don’t make it about reprimands or link it to pay raises, just do it to attempt to improve patient treatment and interactions.

You take in a patient that suffered a fall, follow up the run by telling the medics if there was a fracture or not. Tell them what pain medications were used on the patient during the hospital stay. Was anything else discovered the medics didn’t catch?

Shortness of breath? Tell the medics if it was pneumonia or the flu, what interventions were ordered.

Chest pain, did it end up being a cardiac problem even though its our frequent flyer? Speaking of frequent flyers, so much time is dedicated to ranting and raving about how much of a tax they are to EMS systems, well this method would teach us if that is true in our individual area. I have heard of some systems complain that a frequent flyer is anyone that uses 911 more than 3 times a year and that as little as 100 frequent flyers can cost an EMS system more than 800,000 dollars.

I have also heard of frequent flyers being dismissed as a nuisance and die because of medics telling them to ignore that chest pain and drink some Maalox. How much is the payout on a malpractice suit if it results in the loss of life running these days?

Ahh refusals. That’s a few blog posts on their own.

I think in a short amount of time getting feedback on all our emergency room patient deliveries could greatly improve understanding and aid in patient treatment. I know of many medics that go back and check on their patients, this would just be an expanding of it. I also am not talking about a very costly service. In all likely hood the most important link would be a good relationship with local emergency room staff and whoever is in charge of QA. Trend outcomes, help with things like 12 lead times, stroke, STEMI and trauma alerts could all gain from this. The benefits are truly endless as well as modifiable to individual service needs. Research into medication administration, equipment use such as the AutoPulse or Lucas devices for CPR, and specific interventions can be studied.

I am hoping to introduce this to my department soon and hope they at least consider it. Too many times I see an emphasis on certain types of emergencies and just think a massive blanket review on all transports, at least to start with, could greatly benefit us all.

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