Quality Improvement in EMS

While EMS is often dramatized in big city settings, much of the emergency medicine taking place in the U.S. is performed by small- to medium-sized agencies serving thousands of towns, boroughs and other municipalities across the country. One of the biggest challenges facing quality coordinators at many of these smaller agencies is a lack of resources. Presently, there are no national standards to guide quality coordinators, although—under the leadership of Dr. Ross Megargel—the Quality Improvement Committee of the National Association of EMS Physicians is in the process of working on such standards, which should be released within the next year.

Little, if any, funding exists within most EMS systems for quality improvement programs. And few training programs exist for quality coordinators. The National Fire Academy in Emmitsburg, MD, does offer a weeklong, tuition-free class in quality improvement. But many EMS agencies are so overwhelmed with service volume and lack of adequate funding that they can’t afford to lose an EMS provider for a week, much less pay travel expenses. Very few books have even been written on the subject, and those that have seem to be tailored more toward medical directors than quality coordinators. That is until now.

With assistance from Dr. David Jaslow and Dr. Ken Lavelle, I recently published CQI for EMS—A Practical Manual for QUICK Results, a book written by an EMS quality coordinator, for EMS quality coordinators. CQI for EMS is 10 chapters of lessons learned from the quality improvement programs developed at Bucks County Rescue Squad and Central Bucks Ambulance, two mid-sized EMS agencies in Southeastern Pennsylvania. CQI for EMS is just 108 pages—a mercifully short and easy read by design, for the time-and resource-challenged quality coordinator.

CQI for EMS discusses some of the most common reasons quality assurance programs fail. But it also points out the unprecedented opportunities for quality coordinators to impact patient care. The book details how to take off the blinders and break from tradition to seek improvement. Many misconceptions—which, over time, have become conventional wisdom in EMS—are disproved in order to help you diagnose some unexpected problems, and suggestions are offered to fix them.

We also review how to administer a truly comprehensive quality improvement program by incorporating the three components of quality improvement: it is retrospective (reviewing patient care reports after the call); concurrent (real-time auditing of patient care during calls); and prospective (doing things prior to the call to better prepare EMS personnel to provide a higher standard of patient care). And we end by explaining how to track your progress, perform simple in-house studies and crunch statistics, along with some excellent examples of pitfalls to avoid when utilizing statistics.

I wrote CQI for EMS so hopefully other quality coordinators wouldn’t have to learn lessons the hard way, like I did. I’m a 32-year veteran in EMS. The first 20 years of my career were spent exclusively as an EMT and street medic before becoming the quality improvement coordinator and deputy chief of Bucks County Rescue Squad in Bristol, PA. During my first 20 years in EMS I was also a computer programmer and systems analyst, which provided invaluable knowledge and experience toward developing this new approach to quality improvement.

Co-author David Jaslow, MD, MPH, FAAEM, is presently an ER attending and the chief of disaster medicine at Einstein Medical Center in Philadelphia. Dr. Jaslow started his career in emergency medicine as an EMT with the Bryn Athyn Fire Department in Montgomery County, PA. He has served as the assistant medical director for the Washington, D.C. Fire Department, and medical director for several EMS agencies in Pennsylvania, including Bucks County Rescue Squad, as well as the medical director for both the Pennsylvania state and Federal Technical Rescue Task Forces.

Another major contributor to CQI for EMS was Kenneth Lavelle, MD, FACEP, NREMT-P. Dr. Lavelle, who wrote the foreword for CQI for EMS, spent 10 years working in EMS as a paramedic, including several years as chief of an EMS agency, prior to going to medical school. His primary interest in emergency medicine is EMS medical direction and he has acquired a unique perspective in that he presently serves as the medical director for several fire departments and EMS agencies in two states (Pennsylvania and New Jersey), as well as the District of Columbia.

The greatest value in CQI for EMS is that you can literally read it one day and put the simple—but tried and proven—initiatives into effect the next. CQI for EMS is not meant to be the last word on quality improvement in EMS. But it is designed to help you get your own agency’s program off on the right foot.

You can purchase CQI for EMS at Barnes & Noble.

What Others Are Saying

CQI for EMS: A Practical Manual for QUICK Results by Joseph Hayes, NREMT-P, and David Jaslow, MD, MPH, FAAEM, is the first offering of an organized system for ensuring quality improvement in a very demanding industry. Written by two “veterans of delivering care in the streets,” it is a very practical guide to a complicated system. The book offers insight into the basic elements of a quality program in healthcare, applied to the group of individuals that have the most time-intensive interaction in patient care.

The book offers a step-by-step approach to developing the elementary elements of a system and personnel program. In an easy-to-read and easier-to-apply fashion, readers are able to utilize the manual to build a program in most EMS systems. Particularly relevant to the EMS audience, the program includes elements of retrospective, concurrent and prospective quality measurement. All three elements are essential to an effective program. All are wrapped into a chapter on the use of data and statistical reports that is both simple to read and understand. The manual also includes a comprehensive chapter on program management.

The “practical manual for quick results” accurately describes the content of a book that will be very useful for all EMS leaders, and those who aspire to be. —James J. Augustine, MD, FACEP, Emergency Physician, Fire EMS Medical Director, Former Assistant Fire Chief

Joe Hayes, NREMT-P, is deputy chief of the Bucks County Rescue Squad in Bristol, PA, and a staff medic at Central Bucks Ambulance in Doylestown. He is the quality improvement coordinator for both of these midsize third-service agencies in northeastern Pennsylvania. He has 30 years' experience in EMS. Contact Joe at jhayes763@yahoo.com.