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What is Quality Improvement ?NYS Public Health Law Article 30, Section 3006 (signed into law in February 1995) required every ambulance service and advanced life support first response service to establish or participate in a Quality Improvement (QI) program by January 1, 1997. The law describes the purpose of QI as, “an ongoing system to monitor and evaluate the quality and appropriateness of medical care provided for the purpose of pursuing opportunities to improve patient care and resolve identified problems.” Services are given the option in 3006 of seating their own QI Committee or collaborating with an outside QI Committee. At least 3 of the 5-member minimum must not participate in the care provided by the service being reviewed. The remainder of the law describes the responsibilities of a QI committee and is consistent with generally accepted practices for medical QI. It also provides a cloak of confidentiality for QI documents and participants. The complete text of 3006 can be viewed at the NYS Bureau of EMS website: www.health.state.ny.us/nysdoh/ems/art30.htm. All
ambulance services are required to participate in QI by law.
Fire Departments that respond to EMS calls must also participate in QI.
In Saratoga County, 911 answering points that provide Emergency Medical
Dispatch also conduct regular QI audits. Each
EMS Region in NYS is charged by the State Health Department with facilitating
the QI process with the local services. Saratoga
County is in the REMO Region (www.remo-ems.com)
which has chosen to have individual agencies report their QI activities to
County level EMS QI programs that in turn, pass reports on to the Region.
From 1980 until 2000, there was a single Saratoga County EMS Council QI
Committee. In 2000, QI was divided
in 4 subgroups to better address the unique needs of each EMS service delivery
component. These groups are: BLS
transport, ALS transport, Fire First Response, and Emergency Medical Dispatch.
After a one-year trial, this subgroup concept was deemed so successful
that the EMS Council decided to continue it indefinitely. Duties of QI staff
Each
ambulance corps and fire department has one or more individuals assigned to
oversee the agency QI program. Their
duties follow the three major components of QI: prospective, concurrent, and
retrospective. Prospective
QI includes activities that assure quality patient care before a response.
Equipment and staffing standards, checklists, operational policies and
procedures, medical protocols, copies of certifications, and a program for
continued EMS education are all examples of prospective QI.
Concurrent QI includes
activities that monitor and assure quality at the time the service is being
provided. Supervision or oversight
by a Medical Director/Advisor is an example of concurrent QI.
Retrospective QI involves
activities that look back to see if quality service was given.
Review of patient care records, response surveys mailed to patients and
families, interface with other EMS responder agencies, surveys of receiving
hospitals, response time studies, and high risk call reviews are all activities
reflective of retrospective QI. Each
EMS agency in Saratoga County, at minimum is required to participate in County
level QI meetings as well as submit regular reports summarizing reviews of
patient care records. Each subgroup
conducts additional studies and shares mutual concerns with the other groups.
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