Quality Assurance Program
Contents
Section 2 - EMERGENCY OPERATIONS
220.14 Quality Assurance Program
PURPOSE:
To establish the review of EMS incident reports and on scene care to identify and continually measure the quality of emergency medical care being provided by Maitland Fire Rescue personnel. It is the intent of these guidelines to meet and/or exceed the requirements of Florida Statute 401 and FAC 64-E (section 8).
This review will be used to enhance training and Practice Parameter development/revision through the direction of the Medical Director. This process will improve the overall quality of service provided by the Maitland Fire Rescue Department. Maitland Fire/Rescue Department respects the privacy rights of patients as well as all EMS system providers and will to the greatest extent possible; protect individually identifiable information from public disclosure consistent with Federal HIPAA guidelines. This QM plan details the first four phases of the Maitland Fire/Rescue Department’s medical services QM plan:
- Patient Care Report (PCR) documentation standards.
- In-house PCR QM reviews within each provider agency
- EMS Medical Director QM Patient Care Report reviews
- In-house training as follow up to PCR review
PROCEDURE:
Documentation Standards
Maitland Fire/Rescue Department has developed a minimum documentation standard for over 50 different categories of patient encounters. Each category has specific documentation guidelines to assure complete documentation of the patient’s condition, as well as the treatments provided by the EMS providers.
A copy of the Maitland Fire/Rescue Department’s QM Documentation Criteria can be found at the end of this document, and is incorporated into the QM plan. Every PCR reviewed by the agency’s EMS representative or EMS Medical Director shall be evaluated based on these standards.
Patient Care Report Review Standards
Patient Care Report (PCR) reviews shall be conducted on an on-going basis to provide feedback to the individual providers and the EMS system as a whole. PCR reviews shall be completed internally within Maitland Fire Rescue Department EMS and externally by the EMS Medical Director.
PCR Review:
- Maitland Fire/Rescue Department EMS Agency representative (Shift OIC/Lieutenant, Engineer, Autonomous Paramedic acting in the role of relief driver, and/or Preceptors while precepting a FIT intern) will conduct reviews on every PCR completed as logged and filed within the agency per calendar shift.
- Maitland Fire/Rescue Department EMS shall also conduct PCR reviews for the following types of patient encounters and present the most critical at the next scheduled Medical Director meeting.
- QM’s are to be completed on all reports from the previous shift by 1700hrs.
- MFRD Battalion Chiefs or Lieutenants riding up in the Battalion Chief position shall be responsible for checking the completion of all QA’s monthly to ensure no missing reports.
Any discrepancies or deviations from standing protocols are noted the QA sheet will be forwarded to the Fire Chief or her designee and if need be to the Medical Director for review and evaluation.
Medical Director Review:
The Medical Director shall review the selected PCRs during the monthly Medical Director meeting and issue a written summary of specific and general findings if deemed necessary. This documentation shall be utilized for the agency to provide additional feedback to the individual providers, as well to address agency wide issues.
QM Review:
After the PCR is completed and reviewed on a shift level, it will be ready for the QM review. The Battalion Chief and/or a Lieutenant riding up in the Battalion Chief position will be responsible for completing all QMs from the previous shift (72 hours). Completed PCR reports that require QM review include all transports by a MFRD rescue, ALS refusals, Code terminations, and NCNV calls.
If trends are noted in patient care or treatment the information gathered in the QA program will be used to guide company- wide continued education. The individual provider will have the opportunity to provide written comments regarding the review of the care rendered on the call. If a questionable pattern of behavior is identified in an individual provider, the Medical Director or a designee may choose to do direct clinical observation of the care of that provider in the field. Such reviews are not punitive, but aimed at improving the providers care.
Summary:
The goal of the EMS QM process is to improve patient care through the use of prospective training on documentation standards, retrospective PCR reviews and direct clinical performance observations by Maitland Fire Rescue Department Emergency Services. The cooperation of all EMS System stakeholders in establishing benchmarks and opportunities for improvement is vital and valuable. Finally, this plan outlines the basic, minimum requirement for EMS QM activities for Maitland Fire Rescue Department EMS. All members are strongly encouraged to exceed the standards identified here to assure the highest quality patient care possible.
