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The Utilization of Quality Assurance Methods in Emergency Medical Services

Published online by Cambridge University Press:  28 June 2012

Eric A. Davis  and
Anthony J. Billitier IV
Eric A. Davis*
Affiliation:
Allegheny General Hospital, Pittsburgh, Pa.
Anthony J. Billitier IV
Affiliation:
This work was performed at the Medical College of Pennsylvania, Allegheny Campus, Division of Emergency Medicine, Pittsburgh, Pa.
*
1644 Farmington Ct., Pittsburgh, PA 15237USA
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Abstract

Objective:

The concept of the necessity of a good quality assurance (QA) plan for emergency medical services (EMS) is well-accepted; guidelines as how best to achieve this and how current systems operate have not been defined. The purpose of this study was to survey EMS systems to discover current methods used to perform medical control and QA and to examine whether the existence of an emergency medicine residency affected these components.

Methods:

A survey was mailed in 1989 to the major teaching hospitals associated with all of the emergency medicine residency programs (n = 79) and all other hospitals with greater than 350 beds within the 50 largest United States metropolitan areas (n = 172). If no response was received, a second request was sent in 1990. The survey consisted of questions concerning four general EMS-QA categories: 1) general information; 2) prospective; 3) immediate; and 4) retrospective medical control.

Results:

Completed surveys were received from 78.5% of residency and 50% of non-residency programs. The majority had an emergency medicine physician as medical director (80.1% vs 61.5%, p = .03). While both residency and non-residency hospitals participated in initial public and prehospital personnel education, academic programs were more likely to be involved in continuing medical education (98.2% vs 82.3%, p = .009). On-line (direct) supervision was more likely to be provided by residency institutions (96.4% vs 81.0%, p = .017) which was provided by a physician in 88.3%. Trip sheet review was utilized by 62.0% of non-residency and 75.5% of residency programs responding, and utilized the paramedic coordinator (44.5% vs 46.1%) or medical director (35.7% vs 34.5 %) primarily.

Conclusion:

This survey characterizes some of the current methods utilized nationwide in EMS-QA programs. Further research is needed to determine the effectiveness of these various methods, and to develop a model program.

Keywords

educationemergency medical servicesemergency medicinemedical controlmedical directionparamedic coordinationquality assurancequality improvementresidencytrip sheets
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 8 , Issue 2 , June 1993 , pp. 127 - 132
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

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Footnotes

*

Presented as a Poster at the 6th Annual NAEMSP Conference and Scientific Assembly, Houston, Tex., June 1990.

References

1. American College of Emergency Physicians. Medical control of prehospital emergency medical services. Ann Emerg Med 1982;11:387.CrossRefGoogle Scholar
2. Pointer, JE: The emergency physician and medical control in advanced life support. J Emerg Med 1985;3:31–35.CrossRefGoogle ScholarPubMed
3. Cayten, CG, Staroscik, R, Walker, K, et al. : Impact of prehospital cardiac algorithms on ventricular fibrillation survival rates. Ann Emerg Med 1981;10:432–436.CrossRefGoogle ScholarPubMed
4. Wasserberger, J, Ordog, GJ, Donaghue, G, et al. : Base station prehospital care: Judgment errors and deviations from protocol. Ann Emerg Med 1987;16:867–871.CrossRefGoogle ScholarPubMed
5. Shoemaker, WC, Hopkins, JA: Clinical aspects of resuscitation with and without an algorithm: Relative importance of various delusions. Crit Care Med 1983;11:630–639.CrossRefGoogle Scholar
6. Stewart, RD, Burgamn, J, Cannon, G, et al. : A computer assisted quality assurance system for an emergency medical service. Ann Emerg Med 1985;14:25–29.CrossRefGoogle ScholarPubMed
7. Soler, JM, Montes, MF, Egol, AB, et al. : The ten year malpractice experience of a large urban EMS system. Ann Emerg Med 1958;14:982–985.CrossRefGoogle Scholar
8. American College of Emergency Physicians: Guidelines for emergency medical services systems. Ann Emerg Med 1988;17:742–745.CrossRefGoogle Scholar
9. McSwain, N: Medical control—what is it? JACEP 1978;7:114–116.CrossRefGoogle Scholar
10. Holroyd, B, Knopp, R, Kallsen, G: Medical control quality assurance in prehospital care. JAMA 1986;256:1027–1031.CrossRefGoogle ScholarPubMed
11. Polsky, S, Weigand, J: Quality assurance in emergency medical service systems. Emerg Med Clin North Am 1990;8:75–85.CrossRefGoogle ScholarPubMed
12. Boyd, D: Medical control and accountability of emergency medical services (EMS) systems. Transactions on Vehicular Technology 1979;28:104–114.Google Scholar
13. Diamond, N, Schofferman, J, Elliot, J: Factors in successful resuscitations by paramedics. JACEP 1977;6:42–46.CrossRefGoogle ScholarPubMed
14. Kuehl, AE (ed): EMS Medical Directors' Handbook 1st ed. St. Louis: C.V. Mosby Co., 1989 pp 175–233.Google Scholar
15. Kallsen, G: The nuts and bolts of EMS quality assurance. Handout from lecture at 1988 ACEP Scientific Assembly.Google Scholar
16. Stewart, R: Medical direction in emergency medical services: The role of the EMS physician. Emerg Med Clin North Am 1987;5:199–132.CrossRefGoogle Scholar
17. American College of Emergency Physicians: Medical control in emergency medical services: An ACEP position paper. JACEP 1977;6:568.CrossRefGoogle Scholar
18. Siber, K: Evaluation of emergency ambulance characteristics under several criteria. In: Health Services Research. 1989, pp 160–176Google Scholar
19. Pozen, M, D'Agonstino, R, Sytkowski, P, et al. : Effectiveness of a prehospital medical control system: An analysis of the interaction between emergency room physician and paramedics. Circulation 1981;63:442–447.CrossRefGoogle Scholar
20. Pointer, JE, Osur, MA: EMS quality assurance: A computerized incident reporting system. J Emerg Med 1987;5:513–517.CrossRefGoogle ScholarPubMed
21. Pepe, PE, Stewart, RD: Role of the physician in the prehospital setting. Ann Emerg Med 1986;15:1480–1483.CrossRefGoogle ScholarPubMed
22. Luterman, A, Ramonofsky, M, Berryman, C, et al. : Evaluation of prehospital emergency medical service (EMS): Defining areas for improvement. J Trauma 1983;23:702–707.CrossRefGoogle ScholarPubMed