Q.I.
(QUALITY
IMPROVEMENT)
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Documents
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QI & EMS AGENCIES
In 1996, the New York State Public Health Law (NYS PHL) Article 30 was amended to add the requirement that “...every ambulance service and advanced life support first response service shall establish or participate in a quality improvement program, which shall be an ongoing system to monitor and evaluate the quality and appropriateness of the medical care …and which shall pursue opportunities to improve patient care and to resolve identified problems..” Every certified service was notified by the NYS Department of Health Bureau of EMS (NYSDOH BEMS) regarding this change at that time. Section 3006 very clearly describes the configuration and responsibilities of an EMS quality improvement (QI) program, and includes the expectation that it would have been fully implemented by January 1997.
While this requirement to conduct regular QI assessments has been a component of EMS agency certification for many years, it is recognized by the Westchester Region that this process is not something that may have survived multiple changes in administration, even if it were correctly implemented initially. Most services have had little or no exposure to the principals of a true QI program and may have difficulty designing a system of non-punitive evaluation and implementing a follow-up corrective action plan where problems have been identified.
The Regional Emergency Medical Advisory Committee (REMAC) has developed a Regional QI Plan to assist local agencies in meeting this requirement. The Regional EMS Office is required to collect information regarding local programs and provide records to NYSDOH BEMS on an annual basis.
All agencies are reminded that QI is a REQUIREMENT of NYS EMS Service Certification.
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QI PLAN
The
REMAC QI Committee has asked that all agencies be reminded and
updated regarding the following: 1.
As
per the REMAC Regional Quality Improvement (QI) Guidelines for
Certified EMS Services, Section
8: QI
Information Reporting Procedure: All
ambulance services and ALS first response services shall establish
a QI committee either independently or collaboratively and shall
conduct regular retrospective, concurrent, and prospective review
....QI committees shall develop a written QI plan and/or make
revisions as necessary and submit a copy of the plan to the
Regional EMS Office. Every agency should have submitted to the Region EMS Office a copy of a QI Plan with which they are involved, either independently or collaboratively. The QI Plan should address the items listed in Sections 7 and 10 of the Regional Guidelines. 2.
The first four mandated review topic and QI Committee
reports are due to be filed by all the QI Committees by December
31, 2004. They
are as follows: §
ALS
Criteria Trauma Calls §
ALS
Unavailable when Indicated §
Cardiac
or Respiratory Arrest §
Helicopter
Request Calls 3.
Regional
QI Guidelines. Section
8: QI
Information Reporting Procedure
has had language redrafted to: §
Include
the date parameters for the mandatory PCR review time periods §
Explicitly
allow for monthly PCR pulls for mandatory topic reviews during
each QI review period The
following forms have also been updates or added: §
QI
Committee Report §
Collaborative
QI Committee Supplemental Form Everyone's
participation and support in this process is greatly appreciated.
If there are any questions regarding this notification, or
the Regional QI Plan in general, please do not hesitate to contact
the Regional EMS Office at (914) 231-1616.
QI REFERENCE MATERIALS
After NYS PHL Article 30 was amended in 1996 to include Section 3006, a QI guidebook was issued by the NYSDOH to assist agencies in the formation of an evaluation process as described by statute. This material was included in the Operational Resource Guide issued in 2002 by BEMS to every agency:
Additional resources for developing a QI program can be found by referring to:
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NYSDOH/SEMAC STUDIES -
There are no NYS DOH / SEMAC studies currently ongoing. .
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REGIONAL STUDIES
2007 BLS NEBULIZED ALBUTEROL STUDY
Prompt assessment and treatment of asthmatics having an acute attack remains a goal of the New York State Department of Health (NYSDOH). That is the reason why REMACs were allowed to expand the ability to treat these patients by authorizing certain basic life support (BLS) agencies to provide nebulized Albuterol. BLS agencies participating in this special program are expected to train their EMT-Bs in assessment of an asthma patient and the delivery of the medication intervention as per NYSDOH and regional protocols. EMTs must undergo training updates to maintain their proficiency and ability to participate in the program. The names of these specially authorized EMTs must be filed with the REMAC and kept current.
The outline of the study is simple and is focused the assessment of the patient’s medical history, the severity of the presenting respiratory compromise, the delivery of the medication and the post-assessment of the patient’s condition following the treatment. Informational aids for the 2 methods of assessing work of breathing, the Borg Scale (qualitative) and Peak Flow (quantitative), have been developed and are posted below.
Starting January 1, 2007, when a trained EMTs working with an authorized agency treats an asthma patient with nebulized Albuterol, he or she must complete a survey form (see below). When completed, the survey must be attached to the YELLOW copy of the PCR.
Since this is a QA/QI study, copies of the form will not be left at the hospital for inclusion in the patient record, although the PCR will be provided as usual. All PCRs should be screened by each agency to determine if any forms are missing before submission to the Regional Office. The Westchester Regional EMS Office staff will also verify that each yellow copy of a PCR documenting that a patient was treated by an EMT with nebulized Albuterol has a study form accompanying it. If study forms are found to be missing, the EMS agency will be contacted to retrieve a completed form.
This study will be conducted for 3 months, but may be extended at the discretion of the Regional EMS Office.
Please contact the Regional EMS Office at 914-231-1616 if there are any questions.
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