Continuous Quality Improvement

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Continuous Quality Improvement

• EMS in Chester County

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WHAT IS CQI?

• The concept that there is always room for
  improvement
• A Commitment to constantly improve
• Operations
• Processes
• Activities

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WHAT IS CQI?

• The sum of all activities undertaken to provide
  confidence that the EMS system meets a standard
  of excellence.
• -- Dr. Ron Roth
• Medical Director
• City of Pittsburgh

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CQI IS NECESSARY

• It helps to improve the overall delivery of EMS
  in Chester County
• It promotes improvement
• It shows our customers that the services we
  provide are quality services
• It helps to show our performance compared to
  other systems in the Country

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CQI IS REQUIRED

• While the driving force behind CQI is the desire
  and willingness to improve, there is also a legal
  requirement for CQI
• PA Code, Title 28, Chapter 1001, Section 61
  through 65

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CQI AND TITLE 28

• Title 28, Chapter 1001.65, Cooperation
• Each individual and entity licensed, certified,
  recognized, accredited or otherwise authorized by
  the Department to participate in the Statewide
  EMS system shall cooperate in the Statewide and
  regional EMS quality improvement programs. These
  individuals and entities shall provide
  information, data, reports and access to records
  as requested by the Department and regional EMS
  councils to monitor the delivery of EMS.

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WHO?

• CQI Involves EVERYONE!
• Providers
• Supervisors
• Captains
• Chiefs
• Hospitals
• EVERYONE

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WHO?

• The members of the CQI Committee are
• Adrianne Pohar, Medic 91
• Dr. Larry Anderson, BWH County Medical Director
• John Felicetti, Medic 91
• Bob Hotchkiss, Medic 94 EMS Council
• Cathie Rawlings, Medic 93
• Doug Morrow, University MedEvac
• Nick Campbell, Malvern
• Sadye Sardone, EMS Provider Instructor
• Jeff Gewertz, Minquas
• DES Employees Steve Webb, Harry Moore, Pat Cook,
  Leroy Pierce, and Bob Kagel

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WHAT IS BEING STUDIED?

• To begin only two areas will be examined
• Intubations
• Category 3 Trauma Patients
• As the program progresses, more areas will be
  examined

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HOW IS IT BEING STUDIED?

• The committee will review charts received on a
  bi-monthly basis
• That is where YOU are critical to this process
• Documentation is key, be sure to write a complete
  narrative
• Upon completion of the patient care report, fax
  it to DES at [phone] if it meets the
  criteria for inclusion

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INTUBATIONS

• General
• Was there sufficient documentation indicating a
  need for intubation?
• If yes, was intubation performed?
• If yes, was intubation successful on the first
  attempt?
• If no, was intubation successful within 3
  attempts?
• If no, how was the airway secured?
• Was the method used to secure the tube
  documented?
• Was tube position checked and documented
  initially and after patient movement?
• Was the tube depth documented?

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INTUBATIONS

• What is an attempt?
• An attempt has been defined to be anytime a
  laryngoscope blade is placed in the patients
  mouth

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INTUBATIONS

• Attempts 1, 2, 3
• What was the provider level making this attempt?
• What was the method of attempt? (Oral/Nasal)
• Was there medication facilitation used?
• Was a rescue device used? (Combitube/Trach)
• How was the tube confirmed (Primary Secondary,
  and if documented, tertiary)
• Was the attempt successful?

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INTUBATIONS

• Confirmation
• Was the primary, secondary, and if applicable,
  tertiary means of confirmation documented?
  (direct visualization, lung sounds, SA02,
  epigastric sounds)
• Was an esophageal detection device (EDD) used?
  Result documented?
• Was a colorimetric end tidal carbon dioxide
  (ETCO2) detector used? Result documented?
• Was a digital ETCO2 detector used? Serial
  readings documented?
• Was a waveform ETCO2 detector used? Serial
  readings documented? Printout attached?

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TRAUMA

• We are adding a tracking mechanism for ALL
  traumas
• In order to better track trauma patients in the
  system, we are implementing RESEARCH CODES

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TRAUMA RESEARCH CODES

• 010 If a Category 1 Trauma patient that was
  flown to a trauma center
• 011 If a Category 1 Trauma patient that was
  taken by ground to a trauma center
• 012 If a Category 1 Trauma patient that was
  taken to a local hospital

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TRAUMA RESEARCH CODES

• 020 Category 2 Trauma Patient flown to a trauma
  center
• 021 Category 2 Trauma Patient grounded to a
  trauma center
• 022 Category 2 Trauma Patient taken to a local
  hospital

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TRAUMA RESEARCH CODES

• 030 Category 3 Trauma patient flown to a trauma
  center
• 031 Category 3 Trauma patient grounded to a
  trauma center
• 032 Category 3 Trauma patient taken to a local
  hospital

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TRAUMA RESEARCH CODES

• Where do I document the Research Codes?
• In EMMA, on the Situation Screen
• You will enter the physical codes described
  previously
• In EMStat, on Page 3
• Select from the drop down box the appropriate
  description of the code

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TRAUMA RESEARCH CODES
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TRAUMA RESEARCH CODES
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CATEGORY 3 TRAUMA

• Does the documentation support classifying this
  patient as a Category 3 Trauma patient?
• If no, what makes the reader believe this was not
  a Category 3 Trauma Patient?
• If no, what category does the reader believe the
  patient was?
• If yes, was the patient taken to the appropriate
  facility (local receiving facility)?
• If yes, by what means was the patient
  transported? (air/ground)

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WHERE?

• Where did the criteria come from?
• It all came from the protocols
• Intubations ALS protocols
• Category 3 Trauma Statewide BLS Protocols

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GOALS

• What are the goals?
• Intubation
• 100 indicated intubations recognized/performed
• 80 successful on first intubation attempt
• 90 successful within 3 attempts
• 100 patients with patent/secured airway upon
  arrival receiving facility
• Category 3 Trauma
• 70 compliance for appropriate destination
• 100 compliance for mode of transport

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WHEN?

• This program will begin on April 1, 2006
• April 1 begin sending all charts that meet the
  following criteria
• Intubation attempt
• Patients who meet the Category 3 Trauma
  Classification

APRIL
1
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QUESTIONS OR INFORMATION

• For more information, questions, or to become
  involved
• See any committee member
• Or call Bob Kagel, [phone],
  rkagel_at_chesco.org

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THANK YOU

• Thank you for helping to make EMS in Chester
  County the best it can be!