State of Ohio EMS Performance Improvement

Why? Amended Substitute House Bill #138 requires EMS organizations to implement ongoing peer review and performance improvement programs to improve the availability and quality of EMS services.

(con’t) In implementing these programs, EMS organizations shall consider how to improve its ability to provide effective trauma care, particularly for pediatric and geriatric patients, and shall take into account the trauma care guidelines developed by the Ohio EMS Board.

Performance Improvement Information generated solely for use in a peer review or performance improvement program is not a public record, is not subject to discovery and shall not be introduced into evidence in a civil action.

Purpose Ohio Emergency Medical Service organizations must strive to maximize efficiency, effectiveness, promote excellence and personal accountability through peer review and continuous performance improvement.

Definition Performance improvement (PI): the continuous study and improvement of process, system or organization. Peer review: a team process in which Emergency Medical Service providers continuously evaluate and improve their own patient care delivery system.

Medical Direction Responsible for program content and spearheads leadership for the PI program. Sets the direction for performance improvement by creating a strong patient focus. Helps establish clear statements that define the organization’s mission, values, objectives, and expectations.

Medical Direction (con’t) Establishes continuous commitment to achieving performance improvement goals.

Each Emergency Medical Services Organization will establish: 1. Medical direction oversight. Regional Physician Advisory Board (RPAB) oversight if medical direction unavailable. 2. An ongoing peer review and continuous performance improvement program. 3. Establish a structure and / or membership to implement the PI process.

Con’t 4. Establish performance indicators relevant to their system. 5. Develop a feedback mechanism to the patient care providers.

Intent The intent of any performance improvement program is to:  Provide data and information, in a non- punitive matter, on how well the system and process works.  Implement continuing education, training programs and equipment needs based on outcome data from the peer review / performance improvement process.

To set up: Obtain medical direction or RPAB oversight. Have current prehospital protocols.  Sets the standard of care by which prehospital providers are evaluated.

(con’t) Develop a review process, a method to review runs.  May be a committee or an individual PI Review Coordinator.  May review every run (depending upon run volume) or a percentage of runs, random audits, or sentinel events (unexpected occurrences – involving death or serious physical or psychological injury, or the risk thereof).

Example Following are example protocols from the State of Ohio’s RPAB guidelines. Cardiac Chest Pain Respiratory Distress

Example (con’t) The following slides show examples of review forms that can be used for evaluation of performance improvement based upon the protocols. The peer review process will evaluate the providers adherence to the established standard of care.

Example (con’t) Here is another example using the draft prehospital trauma triage protocols.

Additional Other formats can be developed and used, depending upon system needs. Each system needs to determine which indicators pertain to their system and develop a format to evaluate efficiency and effectiveness.

(con’t) Here is another example using on scene time as the evaluated indicator.

(con’t) Format of evaluation tools may vary. Following is another example of a form that may be used to evaluate run reports.

Feedback Develop a mechanism to provide important performance improvement feedback information to prehospital providers. Maintain confidentiality of patients and providers. Various methods can be instituted to accomplish this (i.e., newsletter, graphs). Decide what works for your system.

Continuing Education Correlate and relate to the identified weak areas. Education is an important component of the performance improvement process. Improves system. Corrects deficient areas.

Re-Evaluate Re-evaluate indicators at a later time to see if there is improvement. Readjust the process with education or communication if there is no improvement, and review the indicators again. This is a continuous process.

Benefits of a Performance Improvement Program Improvement in patient care. Improvement in documentation of patient care. Improvement in compliance. Increased professionalism. Increase in system competency. Increased public confidence.

(con’t) Increased personal confidence. Decreased liability. Positive public relations. Cost containment. Positive impact on financial support from community served.

QUESTIONS?