ALL PERSONNEL SHOULD UNDERSTAND THE MISSION OF THE PROGRAM. THEY SHOULD BE EDUCATED AND UPDATED ON CURRENT ACCEPTABLE CHARTING TECHNIQUES, STANDARDS OF CARE, LOCAL PROTOCOLS, AND THEIR RESPONSIBILITY TO MAINTAIN COMPLETE AND ACCURATE RECORDS. IT HAS BEEN PROVEN IN MORE THAN ONE INSTANCE THAT IMPROVEMENT IN CONTINUING EDUCATION WITH ROUTINE REVIEW AND REINFORCEMENT OF PATIENT CARE PROTOCOLS, MONITORING ACTUAL PATIENT CARE AND FEEDBACK TO THE PROVIDERS IMPROVES TOTAL PATIENT OUTCOME. IN ORDER FOR CQI TO BE EFFECTIVE, SUPERVISORY SUPPORT IS ESSENTIAL, AND EMPLOYEES UNDERSTAND THE DEVELOPMENT OF PLANS AND ONGOING INPROVEMENT. QUOTING A NATIONAL LEADER IN HEALTH CARE QUALITY IMPROVEMENT, "WE HAVE ACCOMPLISHED LITTLE IF OUR EFFORTS IN IMPROVE QUALITY ONLY RESULTS IN OUR ABILITY TO COLLECT AND ANALYZE DATA".

THIS DOCUMENT FOCUSES ON THE REVIEW OF PREDETERMINED TOPICS. IT SHOULD BE NOTED THAT THIS IS ONLY A GUIDE TO AID COORDINATORS IN THE ESTABLISHMENT AND THE ADMINISTRATION OF A CQI PROGRAM. SOME OF THE CQI ACTIVITIES CONTAINED IN THIS DOCUMENT MAY NOT BE APPROPRIATE FOR CERTAIN AMBULANCE SERVICES. THE REASONS AND RATIONALES FOR EACH TOPIC CONFORMS WITH STANDARD OF CARE GUIDELINES ACCEPTED BY MOST HEALTHCARE PROFESSIONALS. CQI IS A PROSPECTIVE APPROACH TO THE REVIEW OF SYSTEMS AND PROVIDES FEEDBACK TO THE INDIVIDUALS. THE KEY IS FEEDBACK AND EDUCATION. IF THERE IS A PROBLEM IT SHOULD BE ADDRESSED THROUGH EDUCATION, NOT BY PUNISHMENT. ALSO, YOUR PROGRAM NEEDS A WAY TO PRAISE AND ACKNOWLEDGE A JOB WELL DONE.

QUALITY IMPROVEMENT IS A SYSTEM OF INTERNAL AND EXTERNAL REVIEWS AND AUDITS OF ALL ASPECTS OF AN EMS SYSTEM. IT IS INTENDED TO IDENTIFY PROBLEM AREAS OF THE SYSTEM OR OF INDIVIDUALS SO THEY MAY BE CORRECTED THROUGH COUNSELING OR EDUCATION. IT IS NOT INTENDED TO BE A PUNITIVE DEVICE. THIS PROGRAM SHOULD BE CONTINUOUS IN NATURE AND GIVE "FEEDBACK" TO THE EMT OR PARAMEDIC IN THE FIELD. IT SHOULD ALSO ALLOW THEM TO COMMENT ON UNDERSTANDING OR MISUNDERSTANDING OF THIS FEEDBACK. OPEN COMMUNICATION SHOULD BE THE KEY TO THE "CONTINUING QUALITY IMPROVEMENT PROGRAM" (CQIP)

AS WITH ANY PROGRAM THERE SHOULD BE SOME TYPE OF COORDINATION. A CQIP COORDINATOR SHOULD BE APPOINTED TO COMPILE REPORTS AND BE RESPONSIBLE FOR THE MAINTENANCE OF PROGRAM RECORDS. A COMMITTEE OF DIFFERENT LEVELS OF HEALTH CARE PERSONEL, IS RECOMMENDED TO PROVIDE THE COORDINATOR DIRECTION AND MAKE RECOMMENDATION TOWARD RESOLVING AREAS OF CONCERN. ADDITIONALLY THEY SHOULD DEVELOP A WORKING MISSION STATEMENT AND OVERSEE THE ACCOMPLISHMENT OF THAT STATEMENT. DEVELOP AREA FOR REVIEW PRIOR TO THEIR OCCURRENCE, ALLOWING FOR PLANNING OF THE REVIEW AND OBJECTIVES. CRITERIA SHOULD BE IN PLACE TO DEFINE HOW TO MEET THE OBJECTIVES, AND THE LIKELIHOOD THAT WITCH HUNTS NOT OCCUR. A MEDICAL DIRECTOR SHOULD REVIEW ALL REPORTS THAT MEET A PREDETERMINED VALUE AND BE ABLE TO MAKE COMMENTS AND EXPRESS CONCERNS INVOLVING PATIENT CARE. IN TENNESSEE, ANY SERVICE PROVIDING ADVANCED OR EXTENDED LIFE SUPPORT MUST HAVE A PHYSCIAN MEDICAL DIRECTOR TO MAINTAIN QUALITY CONTROL OF THE CARE PROVIDED. THE PHYSCIAN MAY INCLUDE ANY OF THE FOLLOWING IN THE CQI ACTIVITIES:

1. DIRECT OBSERVATION OF FIELD PERFORMANCE
2. MONITORING OF RADIO COMMUNICATIONS
3. POST-RUN INTERVIEWS AND CASE CONFERENCES
4. CRITIQUES OF SIMULATED OR ACTUAL CASES
5. INVESTIGATION OF COMPLAINTS
6. OTHER ACTIVITIES THAT PROVIDE INFORMATION ON PERFORMANCE
7. RETROSPECTIVE CASE REVIEW OF SPECIFIC TOPICS