Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-24T09:44:39.506Z Has data issue: false hasContentIssue false
  • English
  • Français

The Effect of a Quality Improvement Feedback Loop on Paramedic Skills, Charting, and Behavior

Published online by Cambridge University Press:  28 June 2012

Robert E. O'Connor  and
Ross E. Megargel
Robert E. O'Connor*
Affiliation:
The Department of Emergency Medicine; The Medical Center of Delaware, Wilmington, Del., Office of Paramedic Administration, Division of Public Health, Dover, Del.
Ross E. Megargel
Affiliation:
The Department of Emergency Medicine; The Medical Center of Delaware, Wilmington, Del., Office of Paramedic Administration, Division of Public Health, Dover, Del.
*
Dept. of Emergency Medicine, The Medical Center of Delaware, P.O. Box 1668, Wilmington, DE 19899USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

A mechanism was initiated for conveying quality improvement (QI) results to paramedics as a means of improving chart documentation in difficult-to-correct areas. This study examines the impact of this QI feedback loop on charting, resuscitation rates from cardiac arrest, endotracheal intubation (ETI) success rates, and trauma scene times.

Design:

Paramedic trip sheets were reviewed before and after the institution of the QI feedback hop in this interrupted time series design.

Setting:

The New Castle County, Delaware, Paramedic Program.

Participants:

All New Castle County paramedics participated in the study.

Interventions:

In January 1990, the medical director began to circulate a QI summary among the paramedics in an effort to improve performance and chart documentation. The summary focused on the management of respiratory distress or arrest, cardiac arrest, and major trauma. The success rate for ETI was compared with the rate of field resuscitation from cardiac arrest, the percentage of unjustified prolonged trauma scene times (longer than 10 minutes), and the percent compliance with minimum endotracheal intubation documetation (ETID) requirements from a six-month period before institution of the QI feedback mechanism with data obtained from a six-month period after the program had been operational for one year.

Results:

Comparing results from before with after the initiation of the QI program, the ETI success rate was 273 of 295 (92.5%) before and 300 of 340 (88.2%) after (X2 = 3.04, p <.1, ns); field resuscitations totaled 26 of 187 (13.9%) before and 44 of 237 (18.6) after (X2 = 1.40, p <.25, ns); ETID rate was 249 of 295 (84.4%) before and 336 of 340 (98.8%) after (X2 = 44.24, p <.001), and unjustified prolonged trauma scene times were 69 of 278 (24.8%) before and seven of 501 (1.4%) after (X2 = 320.5, p <.001).

Conclusion:

The use of QI feedback had little effect on psychomotor skills such as the ETI success rate or resuscitation rate, but had a dramatic effect on chart documentation, as evidenced by ETID rate, and behavior, as evidenced by the reduction in prolonged trauma scene times. The use of QI feedback is recommended as a means of correcting charting deficiencies or modifying behavior.

Keywords

medical directionparamedicsprehospital carequality assurance improvementquality improvementtrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 9 , Issue 1 , March 1994 , pp. 35 - 38
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Johnson, JC: Foreword. In: Polsky, SS (ed): Continuous Quality Improvement in EMS. Dallas: American College of Emergency Physicians, 1992, pp xi–xvi.Google Scholar
2. Wilson, AG: Implementing quality management. In: Swor, RA (ed) Quality Management in Prehospital Care. St. Louis: Mosby-Year Book, 1993, pp 70–79.Google Scholar
3. Stewart, R, Burgman, J, Cannon, GM et al. : A computer-assisted quality assurance system for an emergency medical service. Ann Emerg Med 1985;14:25–29.CrossRefGoogle ScholarPubMed
4. Holroyd, B, Knopp, R, Kallsen, G: Medical control, quality assurance in prehospital care. JAMA 1986;256:1027–1031.CrossRefGoogle ScholarPubMed
5. Swor, RA, Hoelzer, M: A computer assisted quality assurance audit in a multiprovider EMS system. Ann Emerg Med 1990;19:286–290.CrossRefGoogle Scholar
6. Joyce, SM, Witzke, D, Brown, D et al. : Development of an optically scanned EMS reporting form and database for statewide use. Ann Emerg Med 1987;16:508. Abstract.Google Scholar
7. Salerno, SM, Wrenn, KD, Slovis, CM: Monitoring EMS protocol deviations: A useful quality assurance tool. Ann Emerg Med 1991;20:1319–1324.CrossRefGoogle ScholarPubMed
8. Swor, RA, Bocka, JJ: A paramedic peer review audit. Prehospital and Disaster Medicine 1991;6:321–327.CrossRefGoogle Scholar
9. Pepe, PE, Boleubaucher, AS, Mattox, KL et al. : The impact of intense physician supervision on the effectiveness of an EMS system. Ann Emerg Med 1988;17:752. Abstract.Google Scholar
10. Dagher, M, Lloyd, RJ: Developing EMS quality assessment indicators. Prehospital and Disaster Medicine 1992;7:69–74.CrossRefGoogle ScholarPubMed
11. Polsky, SS, Weigand, JV: Quality assurance in emergency medical service systems. Emerg Med Clin North Am 1990;8:75–84.CrossRefGoogle ScholarPubMed
12. Ryan, J: Quality assurance in emergency medical services systems. In: Keuhl, A (ed): EMS Medical Directors Handbook. St. Louis: C.V. Mosby Co., 1989, pp 213–229.Google Scholar
13. Kresky, B, Henry, MC: Responsibilities for quality assurance in prehospital care. QRB 1986;12:230–235.Google ScholarPubMed
14. Council on Medical Service, American Medical Association: Quality of Care. JAMA 1986;256:1032–1034.CrossRefGoogle Scholar
15. McSwain, NE: Indirect Medical Control. In: Keuhl, A (ed): EMS Medical Directors Handbook. St. Louis: C.V. Mosby Co., 198, pp 213–229.Google Scholar
16. Hedges, J, Joyce, SM: Minimum data set for EMS report form: Historical development and future implications. Prehospital and Disaster Medicine 1990;5:383–388.CrossRefGoogle Scholar
17. Soler, JM, Montes, MF, Egol, AB et al. : The ten-year malpractice experience of a large urban EMS system. Ann Emerg Med 1985;14:982–985.CrossRefGoogle ScholarPubMed
18. Shanaberger, CJ: Documentation. In: Polsky, SS (ed): Continuous Quality Improvement in EMS. Dallas: American College of Emergency Physicians, 1992, pp 111–131.Google Scholar
19. Cummins, R, Eisenberg, MS: Prehospital CPR: Is it effective? JAMA 1985;253:2408–2412.CrossRefGoogle ScholarPubMed
20. Steuven, HA, Wake, EM, Troiano, P et al. : Prehospital cardiac arrest- A critical analysis of factors affecting survival. Resuscitation 1989;17:251–259.CrossRefGoogle Scholar
21. Eitel, DR, Walton, SL, Guerci, AD et al. : Out of hospital cardiac arrest: A six-year experience in a suburban-rural system. Ann Emerg Med 1988;17:808–812.CrossRefGoogle Scholar