What Are You Improving At Your Service ?

[crotchitymedic1986]

Although I usually state that a discussion in a forum may do little to affect change or improvement, I hope this thread will actually inspire some people to improve their service.

The question is, what are you currently studying or measuring as a CQI project or improvement project for your service ?

By sharing what you are studying, you may influence someone to look at the same thing at their service, and thus improve the quality of care that they provide.

If you are not currently measuring anything, I hope you will start. Here are some suggestions from me, I am sure others will put forth some better suggestions:

Refusals, and all that has been discussed in previous posts.

Refusal percentage after midnight versus regular hours if you are a 24/48 service.

12-Lead completion

ASA administration

IV or Intubation success rate

Response times

Onscene times

Appropriateness of facility transported to: Stroke, Trauma, Cardiac patients

[spenac]

I am studying protocols for denying transport to those that do not need transport. Any services with such a protocol please PM me with them. I am working on it to get it in my current full time service protocol book.

[crotchitymedic1986]

Good point spenac. The only ones that I ever saw in print, denied transport of:

1. DNR patients

2. Patients with flu symptoms and normal vital signs (had a range and age for fever).

3. Patient with hand, toe, finger fractures.

4. Patients with minor suturable or nonsuturable lacerations.

I will see what I can find.

[spenac]

Exactly as mad as some get when we discuss denying transport they do not realize it is really a limited number of factors that we can deny. But it is still better than wasting resources acting as a taxi.

I would like to establish guidelines to deny all transport for those with no need what so ever. Perhaps be able to take to a clinic those that do need medical care but not really needing an ER.

Of course any protocol for the above will have to include a strong QA/QI to insure that it is being used correctly and not being abused.

[emtannie]

MY focus for this year is on continuing education.

We have a certain amount of continuing education competencies that we have to do in a year (from what I understand, very much like the US) but I have members in my department who dread doing them, and always leave it to the last minute, and rush through, not really gaining any knowledge from the information they have covered.

I have decided that this year, I am developing modules for specific continuing education topics, and once a month, at our regular training meetings, we can work through these modules as a group, and everyone will have completed all their continuing education requirements before the year is through. I did one module in December, and was very pleased to see the discussion that it generated, and members who usually do not do their continuing education until year end were very involved.

It is a good test for me as well, as I have to do the research, design the modules, and have review questions ready for each session. SOme of the information I already have, as I am an instructor, but deciding what to cover, and in what detail, in the time frames I have for these monthly sessions, is part of my challenge.

I hope that this will encourage the crew to review, and learn, and make them better providers.

[VentMedic]

Good point spenac. The only ones that I ever saw in print, denied transport of:

1. DNR patients

Why DNR patients? DNR does not mean do not treat. Even CHF or PNA will be treated with CPAP or BiPAP.

I am not totally opposed to not transporting but unless you also have a reasonable alternative for transportation, you just can't leave a cancer patient to drag their wound vac into a taxi or a finger laceration that needs suturing without some follow up. If the finger becomes infected they could always say you bandaged it and said it was fine. Even EDs have a followup call or visit from a case manager for some of the patients they don't admit into the hospital.

As for improving a service:

I do believe monthly training rather than relying on the required recert CEUs is more effective. There are so many topics that are not covered in some of the recert refresher courses. The changes in laws, regulations, P&P, infectious disease standards, etc should be updated.

[crotchitymedic1986]

Wasnt my policy, just passing it on to Spenac. I believe the rationale was, that if you are a DNR, you do not need emergency ALS services, and could be transported by a convalescent unit. Although most DNR calls are non-emergent (foley or feeding tube change), it is possible for them to have emergencies as you pointed out. As I have stated many times, I would not refuse to transport anyone.

I like the monthly module training idea, whether it goes towards their cert needs or not, I think monthly training should be mandatory. If you can afford it, a good resource is that red and white book that the ER Physicians use (cant remember the name, but it cost around $250.00). It will help you go far deeper than any medic book will. I would also urge you to pick unusual topics, not the usual topics, so that it will be less boring, and people may actually learn something new (instead of just review).

[spenac]

Exactly as mad as some get when we discuss denying transport they do not realize it is really a limited number of factors that we can deny. But it is still better than wasting resources acting as a taxi.

I would like to establish guidelines to deny all transport for those with no need what so ever. Perhaps be able to take to a clinic those that do need medical care but not really needing an ER.

Of course any protocol for the above will have to include a strong QA/QI to insure that it is being used correctly and not being abused.

Protocol will also need to include meds that can be administered while not transporting. Provide relief but when no transport actually needed, not transport. We really need to start acting as Pre Hospital Medical Professionals not taxi drivers.

Vent every patient deserves compassion but it does not mean they all need transport. There is no black and white in EMS, some people will need transported while others with similar but not as bad events will not need transported. Will there be mistakes made, well do errors occur at the hospital? So yes, but in the field most mistakes will probably still be transporting people that do not need transport. DNR still gets any treatment they need based on their instructions. If they just want a ride that could be done by other means then they will be denied and assisted accessing other services, see public education. If you transport everyone only education that public gets is we are a free taxi.

[crotchitymedic1986]

No one else is improving anything ? Dont be shy.

[Christopher.Collins]

No one else is improving anything ? Dont be shy.

Im not saying my department is perfect but I cant think of anything else to improve. We are a progressive Fire/Ambulance service, we have alot of new equipment, the only ladder in town (of 4 districts), one of few con-space and trench rescue units in the county, and our BLS ambulances are stocked with equipment Ive only dreamed of having. The chief has been our chief for some time because he listens to us, knows and supports our wants and needs. The active members of the department are all respectfull of eachother. Frankly, of 4 fire departments Ive been a member of and taking into account many others Im familliar with... this is by far the best run service Ive ever seen.

Again, Im not trying to say we are perfect. The only things I can think of that need improvement is the relationship between our full and part time paid drivers towards us volly guys. When there isnt a job to be done some of them are better than us... fortunatley on the flip side when its time to work they are some of the best guys youd wanna follow into a bad situation.

Id also like to see some active recruitment. We do about 1500 calls a year in our district including EMS... nearly 1800 throughout town and M/As out of town. Since we have the only ladder we are dispatched first due to any fire or smoke condition in town. With that said we have maybe a dozen active and apporopriatley certified members. When I had my interview I handed them a small packet of my credentials, they looked at it smiled and said the interview is over your in. They still talked to me, but I was secure from the start. Most people who join have no certifications what-so-ever and when they find out they need to pursue something within a year of hire they usually quit.

Its a shame really... I see so many horrible departments that are just filled with social life type members. Then here we are with a great department with compasionate officers and a high call volume (for this area of the state) and our manpower sucks.

Unfortunatley Im powerless to help and only contribute to this problem as I will be moving far from the area by the end of next month. Its hard for me to leave because I am happy there and dont want to leave them hanging, but I am also supportive of my wife and relationship as well as our need for some change.