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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.
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
Attachments:
Mandatory
QI Category Forms 
PCR
QI Review Form/Tool 
QI
Meeting Report 
Updated as of
11/15/04
Collaborative
Committee Supplemental Form -
New as of
11/15/04
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
- Language
clarified on first question
- Credentialing section directs agencies participating on
collaborative QI Committee to use Supplemental Form
§
Collaborative
QI Committee Supplemental Form
- Added for agencies participating on collaborative
committee
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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