9 Reasons for Implementing an EMS Quality Improvement Program

EMS Quality Improvement: The Missing Critical Component

Does your EMS agency allocate a sufficient amount of resources to its quality improvement initiatives? If it doesn’t, it should!

Today’s modern EMS system is expected to perform at the highest levels of clinical care. Unfortunately, many services do not have a solid understanding as to how well they perform or whether there are weaknesses in their system; weaknesses that may have a negative impact on patient outcomes. EMS quality is ill defined and even less understood by the general population. We often times use statistics as opposed to quality standards to indicate how well we do. I once heard an EMS manager tell a town administrator that their service was doing a great job as their response times were shorter than the ones called for in the contract between the agency and the town. While response times are an important element of a properly run EMS system, they convey little information as to whether the care provided is actually any good. Isn’t that the real test of an EMS agencies performance?

Many EMS organizations under fund their quality improvement activities. It is often viewed as unnecessary overhead. Most people recognize it is a necessary function (in theory) but do not realize the real value it brings to the organization. In today’s environment there are precious few dollars and a rather long list of needs. It is easy to push the financial needs of the quality control staff to the bottom of the list in order to accommodate more important items. But is that truly in the best interest of the organization? In EMS, as in other aspects of life, the short term answer is often not the best long term strategy. There are many reasons to properly fund and implement a quality improvement program. Let’s start with the 9 most important reasons.

1 – Improved Patient Care

You would think that improving patient care would be a sufficient reason to expend resources to the quality control efforts of an agency. After all, we are in the business of treating and transporting critically ill and injured patients. It would stand to reason we would go to great lengths to continuously improve the service we provide. Unfortunately, we spend more of our money on new pieces of equipment that promise to improve patient care without ever proving the tools perform as advertised. Can we actually show a decrease in morbidity or mortality now that we have that new cardiac monitor?

We have seen countless examples of agencies presenting mounds of data and impressive statistics as proof of a properly functioning quality improvement program and proof of their impressive patient care capabilities. This is worshiping at the wrong alter. The proof of whether a service performs exceptional patient care is not in the equipment or the statistics. It is in the efforts of the men and women who perform the improvement function. That is not to say having good equipment and robust data collections are not helpful in that process. It is simply a tool, but it should not be confused with whether patient outcomes have improved as a result of those items.

A properly functioning quality improvement program should be able to provide hard data showing the improvement to patient care and outcomes as a result of having the right tools for the job. Wouldn’t it be nice to have the data to show key stakeholders that the new CPAP device has resulted in a threefold decrease in patient morbidity. Or perhaps data that shows patients needing intubation (and the subsequent complications and costs) has decreased by 45%. How about your cardiac arrest survival? Can you show that your investment in your new CPR device has improved cardiac arrest survival?

Properly investing in quality improvement can give you the data you need to show how well you perform, and that money spent has been spent wisely.

2 – Improved System Performance

Pretty much any important component of your system can be improved upon, especially if it is measured properly and in an easy-to-understand format. Response times, patient care statistics, the collection of patient demographic data for billing all can be measured and improved upon.

In order to understand what is going on in your department you need to have a system in place to collect data, monitor effectiveness, prescribe the proper mechanism for improvement, and gather the follow up data to ensure improvement is made. Is your mutual aid program working properly? Do you send or receive higher than usual amounts of mutual aid. If so, what is the cause? Perhaps your vehicle maintenance program is not working optimally resulting in your vehicles being down too long resulting in the increased need for mutual aid and a reduction in revenue due to lost calls.

Your quality control efforts should be aimed not only on direct patient care activities but on any activity that impacts patient care. These may include dispatch, equipment maintenance, stock and supply, paperwork processes, certification compliance programs, educational program formats and many more areas for critical overview. One area of strength in the quality program does not guarantee other important areas are not being overlooked. All of which contribute to the overall health and competence of the organization.

3 – Improved Revenue

Many service chiefs have a short-term view of the need for quality improvement. The often-heard mantra is ‘I don’t have the money” for improvement activities. This is a very short-sighted assessment of the department’s needs. Quality improvement activities often add to the bottom line, not detract from it. Agencies that do not have proper oversight usually have higher than average patient refusals or calls that were treated at the BLS level as opposed to the necessary ALS level. Both of these if properly assessed will result in increased revenue which may offset any increase in the quality control budget. Additionally, any improvement effort worth its salt will spend considerable time on documentation (which is a huge area of neglect) which will result in less payer rejections on the billing end and help address a significant risk management issue of potential litigation or accusations of provider misconduct. One lawsuit can bankrupt an agency, but an ounce of prevention in the investment in a quality program can minimize the risk of legal actions.

4 – Decreased Risk to Provider, Agency, and the Patient

Having a properly functioning QA program is a major risk management strategy that pays off in the long run. It can reduce the risk of legal actions, regulatory sanctions, accusations of misconduct, and the public’s perception of your service’s overall competence. One article in a local newspaper (which can now go viral on the internet) can do tremendous damage whether the accusations are true or not. Prevention is the key to success and QA is one mechanism to help you prevent such instances.

5 – Regulatory Requirements

Most state EMS regulatory bodies are now paying much closer attention to quality improvement as a necessary function. In spite of that increased emphasis by such bodies, agencies are still slow to implement quality improvement initiatives. Don’t be surprised if you have an incident and your state regulatory agency criticizes your lack of quality oversight. It may mean the difference between a lower-level sanction for having a quality program that identified the error and aggressively addressed the issue, versus a slow and inadequate response by your service resulting in higher level sanctions.

6 – Improved Monitoring Capabilities by Regulatory Bodies

Every EMS agency in the nation is now sending their data to the federal NEMSIS (National EMS Information System), or soon will be. This program was developed to begin collecting data on a national scale to improve EMS system design, patient care quality, and education. Each state is required to collect the data from providers and forward it on to the federal agency responsible for collecting it. The result of this process is both state regulatory bodies and the federal government now have all of your trip sheet data.

These agencies will be able to mine the data and a result of that process will be the ability to identify areas of weakness for EMS agencies. In the not-too-distant future your agencies quality (or lack of it) will be available for all to see. If you are not dedicating the resources necessary to show you consistently provide high quality care, you may hear about it at your next ambulance inspection. Don’t leave quality to chance!

7 – Legal Defense

Today’s world is a complex one. The expectation of the public is that you are providing them with the highest quality care available. They expect it! They also have tools now available to them if there is doubt. The internet is a rich environment for information. Your state protocols are likely online. Anyone can look up how you should have performed according to state or federal guidelines. Combine that resource with the availability of smartphone videos, YouTube, Facebook and the like and your poor quality (or the perception of it) can get you into big trouble. The best strategy for defending yourself against accusations of poor-quality care is your QA system.

EMS mangers today need to be proactive in seeking out quality care issues before they end up on YouTube. Prevention is the key to survival and your quality improvement activities are the vehicle to get you there safely.

8 – Government and Insurers “Pay for Quality” Initiatives

The federal government and many private insurers have begun instituting Pay for Quality initiatives. They will no longer pay for substandard services from health care agencies. Not only will this have an impact on your revenue stream, but it may also prevent you from billing insurers if you do not have a proactive quality program. Many insurers are now creating websites where physician and hospital performance scores are provided online to inform customers of who the high (and not so high) quality providers are. This increased scrutiny will have a major impact on the financial viability of providers. It will also make available for the world how well you take care of their client’s patient care needs. Can your organization and all the providers in it withstand that level of scrutiny?

9 – It’s The Right Thing To Do!

As a public health organization, you have an obligation and a duty to take care of the sick and injured. Its why you got into this field in the first place. Any agency charged with such a significant responsibility needs to ensure they are performing to the highest level achievable. That can only be done with a well-developed, thorough and comprehensive quality improvement program designed to constantly and continuously improve the level of care provided to the people who rely on us. It’s what we do, and it is the right thing to do!