The Art of Auditing a Run Report
It all starts with a good audit. Understanding the art of auditing a run report is crucial for thorough analysis and insights.
The art of auditing an EMS run report is about identifying what can potentially be improved upon in the patient care experience. An audit is not just about identifying what went wrong. It is about determining what can be done better.
Most EMS CQI programs audit reports looking for poor patient care practices when it should be looking for how things can be done better.
What’s the difference?
Reviewing a PCR for errors in patient care means you are waiting for people to mess up so you can fix their errors. Good CQI is about finding areas that can be improved upon before it becomes a big problem.
For example, in reviewing a PCR you determine that while a provider identified a potential clinical condition, say a patient possibly experiencing a stroke, treated the patient as such and provided a stroke alert, the review also identifies that the provider did not do a comprehensive stroke or neuro exam, or obtain a 12 lead on the patient.
Many CQI programs see this as a minor issue as the stroke was identified and treated. The lack of a thorough exam and the identification of potential differential diagnosis’ means that other conditions could have been missed, or secondary clinical issues ignored.
Just because your auditor agrees with the clinical impression that the medics determined to be the most treatable condition does not mean there is no need for discussion for potential improvement.
Reviewing the case with the providers, even though there may not be a technical protocol violation may provide valuable insight into how the providers think about this type of patient presentation. You may be able to identify what gaps the providers have in their knowledge/experience level that need to be filled for example.
More importantly, you may be able to prevent them from missing essential elements in the future that could lead to a bad outcome. This patient may not have had any complications, but the next one might.
Most errors in patient care by providers are preventable had the CQI process identified these gaps in knowledge or experience before a major error occurred.
Talk to any CQI coordinator and they will tell you they don’t have the time to provide feedback on these “minor” issues as they are too busy trying to find and fix the big stuff. That seems logical on the surface but often results in missed opportunities that lead to bigger adverse events in the future.
Every provider should have feedback that shows them what types of things they may be missing in either their assessment skills, treatments, or documentation that can lead to downstream problems later if not corrected before errors occur. They can’t fix an erroneous thought process if they are not informed that they have an erroneous thought process.
One of the more common comments we hear from field providers when we start collaborating with them is that the things we bring to their attention they have been doing for years and no one ever told them they were potentially problematic.
As an EMS CQI professional or manager of an EMS agency, it is your responsibility to provide feedback to providers that they can use in their practice immediately to improve patient care. That means thorough feedback on even the minor issues.
Each provider should know exactly what types of things they do, or don’t do, that should be corrected to prevent a negative patient outcome before there is one.
The best way to do that is to give feedback that is comprehensive, timely and actionable on the part of the provider. The audit of the PCR is the first step in finding how best to help each provider be the best they can be.
For more information of G&As auditing services contact paul.girard@girardassoc.com or visit our website at www.girardassoc.com
