A Paramedic Peer-Review Quality Assurance Audit

Abstract

Introduction:A daily EMS audit was performed to assess whether a paramedic peer review audit would improve the quality of documentation and radio communications in cases transported to a single receiving facility.Methods:Prehospital EMS run sheets and run tapes were reviewed for adherence to standards developed for the county EMS system. Items evaluated were run sheet documentation of care and paramedic radio presentation. Checklists were used and multiple parameters evaluated for each case. Two periods, 1987–88 and 1989 were compared to evaluate the effectiveness of this system. Care rendered by a total of 106 paramedics was evaluated. Confidence intervals of 0.95 were calculated on the differences between groups. Practicing paramedics audited 63% of the days in 1987–88 and 80% in 1989. Data from each case were tabulated and a profile, average deficiencies per run calculated for each paramedic.Results:A total of 4175 run sheets and tapes were audited for the period 1987–88 with an average of deficiencies/run of 0.27, and for 1989 a total of 1872 run sheets and tapes were reviewed with a deficiency/run rate of 0.21, indicating a statistically significant improvement (0.95 CI= 0.02, 0.08). Twelve paramedics were not auditors in 1987–88, but audited in 1989. Their deficiencies/run decreased from 0.13 to 0.08Conclusion:A peer review audit in this system appears to be effective in improving documentation and radio performance. Performance also improved when paramedics served as auditors.

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

“…Evaluating prehospital care using traditional QI methods is difficult, 34 especially when multiple agencies provide care within one system. 5 Various methods have been developed to better assess EMS including personal computers, 3 5 optically scanned trip sheets, 6 establishment of detailed protocols, 7 peer review, 8 and physician supervision." More comprehensive proposals have involved adapting the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) 10-step model indicators for EMS, 10 and creating an EMS quality assurance (QA) loop.…”