EMS Peer Review: How We Do It, Protect It and Drive Innovation Title: John Enter Romeo, title SCCAD of your presentation here Presenter: Lee Varner, Enter Center your for Patient name Safety here
SCCAD Peer Review
The Goal of QI/QA at SCCAD To deliver the right care at the proper time in the best fashion possible with the BEST outcomes.
Risk management (in any setting)aims to lessen the likelihood of harm materializing from hazards. Goal of medical peer review=improve quality and patient safety by learning from past performance, errors, and near misses. Thus, medical peer review is a potentially very valuable risk management tool.
Origin Already had good QI work being done by Medical Director-both Quantitative and Qualitative. Discussed the need to have peers reviewing each others work. Wanted a robust format where paramedics could give valuable peer feedback to one another.
As Part of Our QI/QA Program
Why??? To ensure quality Collaboration Manage risk Recommendations for safer system Improve the care we deliver
Best Practices
PSO Protections If it wasn t for the federal protections that are allowed in our state and through the PSO, we would not even be having these conversations.
Peer Review Committee Committee A shift Paramedic B shift Paramedic C shift Paramedic Transfer Div. Paramedic Training Officer Battalion Chief Medical Director Advisor Medical Officer - Advisor
What exactly are we doing???
Peer Review Example 68 year old male, Hx of CHF and COPD, c/o SOB. Patient in significant distress. Wheezes precipitate a treatment with Albuterol. Patient deteriorates and has poor outcome.
Feedback and Outcomes Peer review done after the event. Committee reviews and recommends that patient should have received NIPPV. Feedback given to provider (independent of outcome and QI process) that they should have done NIPPV. May recommend education on NIPPV and when appropriate.
Feedback Method
Outcomes/Benefits Outcomes Pull 5 random trips per month; becomes PSWP. Benefits Feedback is from peers and valuable. Trips may be referred in via the provider themselves or any other providers. When issues are identified, the committee may make recommendations. Provider(s) on the call get feedback from peers about care provided and how they handled it. Feedback is free of any hint of discipline.
Peer Review = Improvement Can use outcomes as lesson learned for individuals or as a system improvement opportunity. Training Able to use feedback once it is de-identified as opportunity for improvement. These lessons learned can then be used in training to improve the system and outcomes.
Peer to Peer Checking
Just Culture
Just Culture An atmosphere of trust in which people are encouraged to provide essential safety related information. Must acknowledge that all humans are destined to make mistakes and destined to drift into at-risk behavioral choices, regardless of how well a system is designed. In a Just Culture, the shift has to go from errors and outcomes to system design and behavioral choices.
Questions???
Patient Safety Organizations
Center for Patient Safety PROTECTING. Protect patient safety and quality work. PATIENT & PROVIDER SAFETY PREVENTING. Prevent adverse events and patient harm through supportive cultures. LEARNING. Learn best practices and improvement opportunities.
The Problem No protections, placing your work open to discovery Nobody wants to talk about their mistakes It has only been within the last decade that significant verdicts have been rendered against EMS providers. (page 9 EMS and the Law)
A law is AVAILABLE to help The Patient Safety and Quality Improvement Act of 2005 (42 U.S. Code Part C - Patient Safety Improvement) Establishes a framework that encourages adverse event reporting Establishes a network of Patient Safety Organizations (PSOs) Focuses on sharing, learning and prevention 24
A law is AVAILABLE to help The Patient Safety and Quality Improvement Act of 2005 (42 U.S. Code Part C - Patient Safety Improvement) Federal law and regulation Intent of the PSQIA: LEARN. BE PROACTIVE. REDUCE COST. REDUCE HARM. 25
PSOs THE SOLUTION Protect safety & quality work Share in a safe way Learn why things happen
Patient Safety organizations (PSO) What is a PSO? An organization that collects data from participants (you), studies it and develops and supports recommendations for safer care Who can participate with a PSO? Any licensed provider What is reported to a PSO? Medical errors, near misses, unsafe conditions
Patient Safety organizations (PSO) How do PSOs improve safety? PSOs aggregate data Providers can work together PSOs are non-punitive Providers receive protections 28
QUALITY & SAFETY IMPROVEMENT WORK Actions You Are Taking Now Focused trip reviews Investigation of incidents Case reviews with the Quality Committee meetings Documents You Are Collecting Supervisor notes of trip reviews Medical Director case review notes/recommendations Meeting minutes Investigation notes Emails Reports or analytics from epcr or other software
Patient Safety organizations (PSO) PSO COLLECTS DATA DATA IS ANALYZED LESSONS ARE SHARED Air Medical Service EMS Fire Based EMS Hospital Based Private Ambulance Svc PUM Airway Crashes Devices Medication STEMI/STROKE OTHER PSO TYPES OF EVENTS COLLECTED ADVERSE EVENTS NEAR MISSES UNSAFE CONDITIONS Only CPS has AHRQ-based common data formats for EMS.
Patient Safety Organizations (PSO) PSO COLLECTS DATA DATA IS ANALYZED LESSONS ARE SHARED Airway Crashes Devices Medication STEMI/STROKE OTHER PSO TYPES OF EVENTS COLLECTED: ADVERSE EVENTS NEAR MISSES UNSAFE CONDITIONS Only CPS has AHRQ-based common data formats for EMS. 31
Patient Safety organizations (PSO) PSO COLLECTS DATA DATA IS ANALYZED LESSONS ARE SHARED PSO Event reports are analyzed confidentially by a team of experts looking for trends, causal factors, types of events, quantity of events, quality of data, unusual incidents, etc. 32
Patient Safety Organizations (PSO) PSO COLLECTS DATA DATA IS ANALYZED LESSONS ARE SHARED PSO TYPES OF EVENTS COLLECTED: ADVERSE EVENTS NEAR MISSES UNSAFE CONDITIONS Best Practices Alerts/Watches Resources/Toolkits Newsletters Webinars Conferences/Meetings Air Medical Service EMS Fire Based EMS Hospital Based Private Ambulance Svc PUM
A JUST CULTURE BALANCED ACCOUNTABILITY Optimal Support for a System of Safety What system of accountability best supports system values? SUPPORT OF SYSTEM VALUES As applied to: Employees Managers Institutions Regulators BLAME-FREE CULTURE No Accountability PUNITIVE CULTURE Transparency is Impossible Adapted from Outcome Engenuity 34
REASONS TO PARTICIPATE IN A PSO You may fear increased liability from participating in quality initiatives You may have insufficient volume to perform analyses All licensed healthcare facilities and clinicians can participate You may currently lack feedback Protections are nationwide and uniform You do not currently have protection for deliberations or analyses
PSO s ARE ABOUT PREVENTION! By reinforcing a safety culture that allows healthcare providers to safely report and share Patient Safety Organizations (PSOs) support the collection and patient harm. analysis of events, Dr. William Munier and share learning. information about vulnerabilities within the healthcare system, PSOs are pivotal in the crusade to prevent medical errors and Agency for Healthcare Research & Quality
Improving patient safety
Closing A commitment to Peer Review takes work. Collaboration is KEY!!! Can be a great part of a comprehensive QI/QA program. Can help organizations IMPROVE CARE DELIVERED. May help in better understanding safety and managing risk.
John Romeo, BSN, RN, EMT-P Chief Medical Officer St. Charles County Ambulance District Jromeo@sccad.com (636-344-7638 Lee Varner, MSEMS, EMT-P Project Manager, EMS Services Center for Patient Safety lvarner@centerfor patientsafety.org (314) 614-8103