Journal of Emergency Medical Services

TRACTION IN FORWARD AND REVERSE FOR 1/2 TON TO CLASS 8 VEHICLES

• UTILITY TRUCKS • FIRE TRUCKS • AMBULANCES • SCHOOL BUSES • PLOW TRUCKS • TRACTOR TRAILERS

*Approved for use in states with chain control areas

appropriate individual within the PCR author’s department—often the EMS supervisor or quality improvement manager, depending on the organization’s policies.

Because the PCRs are reviewed by the software immediately, feedback and coaching can be provided while the call is still fresh in the minds of the EMTs and paramedics.

In addition, the compliance with the entire bundle and with each of the criteria can be measured and tracked at the individual, department and systemwide levels.

COMMUNICATION
& FEEDBACK

Pinellas County also implemented a campaign to ensure that each EMT and paramedic in the system understood the clinical and legal risks associated with patient refusals, how to conduct and evaluate a proper EMS cognitive evaluation, the rationale for obtaining two sets of vital signs, the importance of good documentation and the seven tests included in the refusal bundle of care.

The campaign was conducted via email, Facebook and newsletters, as well as in the classroom. Conversations about patient refusals were built into new employee orientation and field training officer programs.

“We didn’t just turn this system on full throttle overnight,” one
EMS captain said. “We rolled it out over 18 months of planning and
lots of beta testing. Full implementation felt for some people like we
went from 0 to 1,000 mph, but they have been impressed by how much
improvement we’ve made so quickly.”
Once the campaign was well underway, the clinical leadership teams
began providing feedback to crews whenever a call was flagged in First-
Pass. Each department handles the coaching and feedback process in
a way that works for them. One department prefers group emails and
communication over individual feedback, while another department
schedules weekly one-on-one meetings with every medic on its team.

Even though they customize the feedback process, all 19 departments provide feedback quickly and carry the same patient-centered non-punitive message; they also coordinate efforts with the county medical director and follow the same policies to determine when it is necessary to notify Jameson.

DRAMATIC RESULTS

The results of their efforts to improve care for patients who refuse transport have been dramatic (See Figure 2, p. 63.).

“For the longest time, QA was viewed as the, ‘ What have you done
wrong today club,’” an EMS captain said. “With our change to Just
Culture combined with the nearly instantaneous feedback facilitated
by FirstPass, we can concentrate on what [we] are doing right. I send
out a thank-you letter signed by the chief for every medic that has
100% performance on our clinical protocols. I used to send out 12 to
20 a month, now it’s between 170 and 180 a month.”
Transitioning to a true quality management system, rather than a
quality assurance system that only looks for mistakes and slaps pro-
viders on the wrist, has also allowed for evaluation not just of adher-
ence to clinical protocols but also whether those protocols are, in fact,
the best for the system.

That goes not only for refusals, but for other patient care bundles being continuously assessed in the system, including cardiac arrest, major trauma, acute coronary syndrome and others.

“Once we have the system reliably providing care in alignment with the protocols and documenting it properly, it’s possible to evaluate trends and really see how well the protocol is serving our patients,” Jameson said.

“We fine-tuned our chest pain
protocol to optimize recogni-
tion of STEMI faster and to better manage pain as early as possible.”
By tracking performance over time, building a non-punitive
just culture, using near real-time analysis tools, and having a truly
patient-centered, collaborative approach,
the departments delivering EMS in Pinellas