There are many ways to look at QA. The good news is it does not have to be a negative one.
What is Quality Assurance?
Quality assurance, or QA as it is known for short, is a process of reviewing medical records (EMS run reports) and determining how well medical care has been administered, as well as how well we have followed the protocols of the system.
The medical professional reviewing the run report is generally a counterpart, or coworker, of the person administering the care.
I can explain in my years in EMS that I have had many feelings concerning QA. I have been worried and nervous after a run and thinking about the care I provided and hoping that I did it right. I have also been mad at someone for noting failures on my part for not following the protocols.
I am sure that many of you reading this article can name others that have had many experiences similar to mine. You might have even had these reactions.
With Pitt County EMS our QA is set up in a twofold process. If I would go on a run today, then the oncoming crew will review the run report during their shift and make some general reviews. The crew will ensure that run numbers are correct, all documentation is complete, and other necessary items are present (these are systemic issues). Then the Peer Review Team will take the run reports and thoroughly check them for protocol adherence and proper medical care administration. After run reports are reviewed, the team will notify the staff of common and often occurring mistakes. This process seems to have little distress on the shifts, but seems to allow for benefits.
Why do we feel this way
Most people feel this way towards QA because if we are noted for issues, we feel we are failures or are not doing our jobs well. It could also be due to one’s fear of losing their job (if you are career), or being sued for medical care.
Why should we not feel this way?
First, and foremost in my opinion, QA is not only about us. It is about the patient and the care they needed/received. We should all want to ensure that the care we are providing is making a difference to a person that is in need in one facet or another. This is, of course, mainly why most of us do this as a volunteer or career medical professional.
Secondly, and this is connected to the first in ways, we should always want to make ourselves better in this role. Knowledge is power. The more we know about our positive outcomes and our failures, we can make subtle changes to our care that can make large changes in the outcome of our patients. This knowledge is something that is derived from the QA process.
One aspect we do need to work on is the systems ability to acknowledge positive outcomes. In Pitt County we are using a newer STEMI activation process to assist getting patients to the catheter lab faster, thus reducing loss of heart muscle and risk of further injury and or death. QA and communication with the hospital staff is showing that our process is working well. We are seeing few false alarms and door to balloon times as low as 30 minutes.
So, I challenge all EMS professionals, including myself, to be more open to the QA process. It is here to enhance our care giving. It is here to enhance our care and outcomes for our patients. Changing this mindset will be beneficial to all.
SPECIAL NOTE: Thanks to the Pitt County Peer Review Team and the Pitt County EMS staff for allowing me to use our system as an example.