Page 16 - PFFW December 2018
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                                 Continuous Quality Improvement Can Help Take the ‘Mess’ Out of EMS
We have witnessed a sharp uptick
in unnecessary, negative, and costly investigations into emergency medical care provided by EMTs in Wisconsin. To set the record straight early on, Continuous Quality Improvement (CQI) is a necessary and critical component to ensure provider safety, patient safety and effective response. We must have a consistent, practical and fair way to safeguard the mission to be the best EMS providers possible. We must also recognize that human error can occur.
When an error occurs, how do labor representatives work to assure that both the provider and supervisor walk away from a meeting confident that the outcome was in the best interest of all involved, including the patient? It is important that the provider was appropriately remediated through education and confidence building. It is likewise important that the supervisor feel due process was successful and learning will take place. CQI should be a process that the medical director, administration and providers believe in, and that is applied equally and fairly. If
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you believe that you operate in a fear-based culture, there is a high likelihood that your CQI policy needs immediate attention.
First, evaluate how your organization currently mitigates EMS errors. There is no GPS that can tell you how to get somewhere without knowing where you currently are. This process may be a bit painful because we’ve handled some events wrong. This knowledge is also part of the CQI process. Own it! It’s
a benefit to everyone to realize that we can
do better and fix it, rather than continuing
to repeat the same errors, and for negative preventable outcomes.
Next, determine where you’d like to take the organization. Ultimately, we want employees to feel comfortable and safe from formal discipline and to self-report errors. We also want supervisors to feel safe from walls being put up when sharing their findings with EMS providers, and implementing an educational plan to avoid repeating medical errors. For us to show our commitment to maintaining a culture of high-quality EMS care, we must
foster an environment for safe discussion and collaboration where supervisors and members may speak freely but professionally. An environment, too, where all data are managed sensitively and are compliant with HIPAA, where all stakeholders have accountability and where input is welcome through defined ground rules.
As a paramedic in Milwaukee County EMS (MCEMS), it’s the system’s position that the delivery of EMS care is challenging given the dynamics, austerity, lack of resources and myriad other factors. When errors occur, they are almost always the result of systems and environments and rarely the choice of the provider. To that end, the focus of MCEMS
is to use errors that occur as an opportunity to continually improve the delivery of EMS care. I am completely sold on the great work of Milwaukee County EMS and their guiding mission to “Drive Excellence in Prehospital Care.”
MCEMS adopts a Just CultureTM type approach to patient safety events so that they can

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