Quality Improvement and the Future of EMS
Quality Corner was the first and, as of this date, the only monthly column dedicated to quality improvement in EMS. But as all good things must come to an end, so it is that the final curtain will fall on this column as of this writing. I only hope the ideas and lessons that were shared here over the past four years were half as helpful to you as they have been enjoyable for me to write.
As I’ve previously mentioned, being the quality coordinator is the most glamorless and thankless job in all of EMS. It’s also arguably the most important job. Because most of EMS in the United States is made up of small- or medium-sized agencies, adequate support for quality improvement is frequently lacking. In most cases being the quality coordinator is extra duty with no dedicated time or resources provided. Many quality coordinators perform their primary duties as an EMS provider, and review patient care reports when they can. Additionally, many quality coordinators never get the opportunity to perform any of the other critical functions of quality improvement such as real time auditing of patient care in the street.
The main objective of Quality Corner has been to offer support, ideas and resources to make the quality coordinators job a little easier. We did this most notably by publishing the ideas and lessons learned of the host author as well as guest columnists which represent some of the great leaders in EMS today such as; Jim Augustine, MD, David Jaslow, MD, Ken Lavelle, MD and Craig Hall, NRP. Some additional resources made available have been the Ten Commandments of Quality EMS, and the book by the author of this column CQI for EMS – a practical manual for QUICK results designed to help with the startup of a comprehensive quality improvement program.
Another recent valuable resource external to this column is EMS Compass, which assists the quality coordinator in improving patient care by performance measurements and is sponsored by the National Traffic Safety Administration (NTSA) and the National Association of State EMS Officials (NASEMSO).
Most states require EMS agencies to have a quality improvement program, but the truth is in many cases these quality improvement programs exist in name only and become active only after a complaint is filed. This of course undermines the whole concept of quality improvement: to identify and correct issues in order to prevent negative incidents from occurring.
Some EMS agencies have been able to get away without having a legitimate quality improvement function for some time, but that will not be possible for much longer. A major component of insurance reimbursement today and destined to be an even bigger component in the future is quality parameters in patient care. The rest of medicine has been dealing with this for some time now and EMS is about to be initiated. Instituting performance requirements where none existed before will always be an immediately challenging process. But truth be told, nothing affects change quicker than financial incentives—or penalties.
To even have a chance at making this transition will require an active quality improvement process. The upshot of this is of course better patient care. And, if fairly and reasonably applied, appropriate financial compensation would be the reward. The problem will be the fair and reasonable part of this proposition.
That brings us to the giant elephant in the squad and treatment rooms—the Affordable Care Act. Ready or not and like it or not, here it comes.
Just as advertised, it could greatly reduce morbidity and mortality as well as be much more cost effective than the no-system of the past if done correctly. Unfortunately for patients and healthcare providers, national healthcare finally came of age at a time when our congress is barely capable of keeping the wheels of government turning from year to year much less accomplish great things as they once could.
One party will intentionally sabotage legislation meant to improve lives with counterproductive amendments just to keep the other side from being able to claim a political victory. And regardless of how damaging the final version of that legislation may end up being, the originating party will push it through rather than admit political defeat. The result so far has been skyrocketing health care premiums from price gouging by the insurance companies on the one end and deceasing reimbursements to healthcare providers on the other.
Putting country ahead of party is no longer even possible in Washington as it was for most of our previous existence. And if you ever wondered how the decline and fall of all the great nations before us occurred, you need only look to our own capital for the answer. Great nations ultimately do not fall due to the actions of foreign enemies they fall because of the arrogance and incompetence of their own leaders from within.
God Bless Help America!
Joe Hayes, NREMT-P, is deputy chief of the Bucks County Rescue Squad in Bristol, PA, and a staff medic at Central Bucks Ambulance in Doylestown. He serves as the quality coordinator for both of these midsize third-service agencies in Southeastern Pennsylvania. Joe has over 35 years’ experience in EMS. Joe is also the author of the book; CQI for EMS–A practical manual for QUICK results and, in 2014, founded the National Association of EMS Quality Coordinators (NAEMSQC). Contact Joe at jhayestpc@gmail.com.
