Galveston Area Ambulance Authority
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QUALITY ASSURANCE/ QUALITY IMPROVEMENT PROGRAM FOR Galveston Area Ambulance Authority February 2010 Updated: August 2012
Transcript of Galveston Area Ambulance Authority
QUALITY ASSURANCE/ QUALITY IMPROVEMENT
PROGRAM
FOR
Galveston Area
Ambulance Authority
February 2010 Updated: August 2012
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Table of Contents
TABLE OF CONTENTS ...................................................................................................... 2
INTRODUCTION ................................................................................................................. 3
DIRECTIVE AUTHORITY ................................................................................................ 4
CONFIDENTIALITY ........................................................................................................... 5
QUALITY ASSURANCE REVIEW ................................................................................. 6
ADDITIONAL GUIDELINES ........................................................................................... 8
QA/QI COMMITTEE .......................................................................................................... 9
INVESTIGATIONS AND NOTIFICATIONS ............................................................. 10
APPENDIX ........................................................................................................................... 11
ELECTRONIC PATIENT CARE REPORT (EPCR) REVIEW CHECK LIST ................... 12
ELECTRONIC PATIENT CARE REPORT (EPCR) REVIEW CRITERIA ....................... 14 DISPATCH REVIEW CHECK LIST ................................................................................... 18 DISPATCH REVIEW CRITERIA ....................................................................................... 19
GAAA QA COMMITTEE LETTER .................................................................................... 21 GAAA EDUCATIONAL RECORD/ SKILLS REVIEW .................................................... 22
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Introduction It is the mission of the Galveston Area Ambulance Authority (GAAA) and Galveston County
Health District (GCHD) to provide expedient and high quality emergency and non-emergency
medical care and transportation to Galveston County residents and visitors. Consistent with
this mission, our goal is to provide care that is:
Safe - avoiding injuries to patients from the care that is intended to help them;
Effective - providing services based on scientific knowledge to those who would benefit,
and refraining from providing services to those not likely to benefit;
Timely - reducing waits and potentially harmful delays;
Efficient - avoiding waste, including waste of equipment, supplies, ideas and energy;
To achieve this goal, the GAAA will participate in an ongoing and systematic quality
assurance and quality improvement program. Program efforts will focus on direct patient care
delivery and support processes that promote optimal patient outcomes and effective financial
practices. Additionally, because EMS does not exist in isolation, care must be evaluated as it
relates to the healthcare systems throughout the area. This program demonstrates GAAA’s
commitment to advancing the quality of care we deliver. It outlines the goals and strategies
for ensuring patient and provider safety, delivering optimal care, and achieving high patient
satisfaction.
This Quality Assurance/ Quality Improvement (QA/QI) Program is a systematic evaluation to
ensure excellence in care within the operations of the GAAA EMS system. Quality Assurance
is a formal methodology designed to assess the quality of services provided and includes
formal review of care, problem identification, corrective actions to remedy any deficiencies
and evaluation of actions taken. Quality Improvement is a continuous process that identifies
problems in health care delivery, examines solutions to those problems, and regularly
monitors the solutions for improvement. This program will focus on ways to improve pre-
hospital care rather than administering discipline and criticism. However, corrective actions
for failure to follow GAAA/GCHD protocols, policies, procedures, and guidelines will occur
when the situation warrants discipline in accordance with the GCHD Corrective Action
Policy.
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Directive Authority The GAAA Medical Director shall maintain the authority to both approve and/or revoke local
medical provider privileges of GAAA personnel operating at any level: EMT-B, EMT-I, or
EMT-P. When serious problems in patient care are identified, the GAAA Medical Director
may take such action prior to, during, or after an investigation of an incident or patient care
issue. The GAAA Medical Director will notify the GAAA Director immediately of any
decision to revoke the local medical privileges of a provider with the GAAA Director
notifying GCHD Human Resources and GCHD Risk and Safety. A letter of privilege
revocation will be given to the employee and placed in the employee’s permanent file. GCHD
Human Resources will determine what action to take in accordance with GCHD Corrective
Action Policy, i.e.: (suspension with/without pay pending investigation, recommendation of
termination).
In the event that local privileges are revoked, the GAAA Medical Director, GAAA Director,
GAAA QA Coordinator, and GAAA Training Coordinator, will review the merits of the
revocation and provide a referral for investigation to the Texas Department of State Health
Services-EMS/Trauma Services Division where warranted. A copy of this referral will be
filed with GCHD Human Resources, and GCHD Risk and Safety.
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Confidentiality The QA/QI Committee outlined in this program is a medical peer review committee. As a
medical peer review committee, all proceedings, reports, and records of the Committee are to
be kept confidential within the GAAA/GCHD system.
No member, consultant, advisor or person supplying information to the Committee shall
disclose information concerning matters submitted to, considered by, or issuing from the
Committee. Unauthorized disclosure shall be grounds for disciplinary action in accordance
with the GCHD Corrective Action Policy, including termination of local medical provider
privileges. No disclosure of any such interview materials, reports, records, statements,
memoranda, proceedings, findings, or data shall be made without the authorization of the
GAAA Director or his/her designee.
Unlike treatment situations when you normally share an entire record with other treating
health care providers, a "minimum necessary" standard applies to most QA/QI activities. This
standard essentially limits the information disclosed to the minimum necessary information
needed to accomplish the task.
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Quality Assurance Review
The GAAA QA Coordinator is required to attend periodic meetings with the GAAA Medical
Director throughout the year at a rate determined by the GAAA Medical Director and at
special notice. The GAAA QA Coordinator may make recommendations only, to the GAAA
Director, GAAA Medical Director and GAAA Training Coordinator about educational and/or
disciplinary actions for a provider. When disciplinary action is warranted, it will adhere to the
GCHD Corrective Action Policy.
The GAAA QA Coordinator will see that all Electronic Patient Care Reports (ePCR) will be
reviewed. The review will be performed initially by a GAAA Field Supervisor with
experience sufficient to adequately perform the function. A paramedic level or higher will
review ALS Run Forms. Individuals may not review forms for which they were attending
provider, Team Captain, Senior Team Captain, and/or filled out the form. If an alternate
person is not available, run forms may be brought to the monthly GAAA QA Committee
meetings for review.
The review will include, at a minimum, evaluation of:
Run Times,
Form Completeness,
Readability,
Use Of Proper Terminology,
Interpretive Findings (Diagnostic Skills),
Adherence To Operational Policies,
Adherence To Treatment Protocols.
Additionally the run review form contained in the appendix of this document (pages 15 & 16)
will be utilized for the following:
All ALS runs
All BLS runs that meet the criteria to be forwarded to the GAAA QA Committee (see
below)
Every 10th
BLS run
Initially, the following run reviews (ALS & BLS) will be forwarded to the GAAA QA
Committee:
All reviews in which there are four (4) or more "Improvement Needed" or "Absent"
ratings in the Documentation section,
All reviews in which there are less than four (4) "Improvement Needed" or "Absent"
ratings in the Documentation section where medical care could have been
compromised by the lack of documentation,
All reviews in which there are ANY "Improvement Needed" or
"Unacceptable/Inappropriate" ratings in the Clinical section.
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All reviews in which a "Requires Further Investigation" in the Clinical section
becomes an "Improvement Needed" or "Unacceptable/Inappropriate" rating after
investigation or the investigation requires the input of ER staff.
Any other reviews in which the GAAA QA Coordinator, Supervisor or field personnel
has concerns and wishes to send to the Committee.
Any reviews in which there are less than four (4) "Improvement Needed" or "Absent" ratings
in the documentation section or issues dealing with GAAA/GCHD operational procedures,
guidelines, and policies other than medical care may be dealt with according to GCHD
Corrective Action Policy if medical care was not likely to have been compromised.
The criteria for run review submission to the GAAA QA Committee is decided by the GAAA
Director, GAAA Medical Director, and GAAA QA Coordinator, and may change as needed.
When specific medical standards are not available, the GAAA Medical Director shall
provide needed guidance and make decisions regarding the appropriateness of care.
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Additional Guidelines 1. All GAAA personnel must maintain the requirements for their certification level with
Texas Department of State Health Services, and be authorized to practice by the GAAA
Medical Director. Under certain circumstances the GAAA Director or GAAA Medical
Director may require additional information and a clinical skills evaluation to be
considered in good standing and eligible for medical provider privileges within the GAAA
system.
2. All GAAA personnel are encouraged to maintain certification in Advanced Cardiac Life
Support (ACLS), Pediatric Advanced Life Support (PALS), Advanced Medical Life
Support (AMLS), and Pre-Hospital Trauma Life Support (PHTLS) or International
Trauma Life Support (ITLS).
3. Periodically, when they can be made available, copies of dispatch radio
reports/transmissions will be requested from Galveston County/City of Galveston/UTMB
Dispatch for review by the GAAA QA Committee. Additionally tapes can be requested
from Dispatch any time the review of a run includes detailed dispatch information. The
tapes will be reviewed for:
Professionalism,
Clarity,
Use Of Proper Terminology,
Appropriate request for medical direction,
The GAAA QA Committee may also choose to perform further investigation or
recommend corrective action in accordance with the GCHD Corrective Action Policy,
including providing education to personnel regarding any identified problems.
Additionally, Radio transmissions may be played at GAAA Staff Meetings or GAAA
Supervisory meetings or during GAAA training sessions for educational purposes.
4. GAAA personnel will periodically update their certification level clinical skills with the
GAAA Training Coordinator or Supervisory personnel.
5. GAAA personnel may periodically have their skills reviewed through
Paramedic/Physician meetings if deemed necessary.
6. Annually awards and recognitions will be presented by the GAAA QA Committee for
excellence in EMS documentation and patient care. The awards will be chosen by the
GAAA QA Committee and be presented by the Committee Chairman or Vice Chairman if
possible.
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QA/QI Committee The QA/QI Committee will consist of the following individuals:
GAAA Medical Director (Chair)
GAAA EMS Director
GAAA Quality Assurance Coordinator
GAAA Training Coordinator
GAAA Supervisory Personnel
The members of the QA/QI Committee are responsible for:
Meeting monthly at dates and times agreed to by all members. Extenuating
circumstances may cause meetings to be postponed or cancelled where warranted;
Assuring that the procedures outlined in this plan are completed;
Incorporating any additional procedures required by Galveston County Health District
(GCHD);
Assuring that the data obtained through QA/QI activities are analyzed,
recommendations made, and appropriate follow up of problem resolution is done;
Reporting on ongoing findings, studies, recommendations, and trends to GAAA staff
and GCHD administration;
Reporting to ER staff as appropriate;
Identifying and reporting individual personnel and/or system educational needs to
GAAA Director, GAAA Medical Director, and GAAA Training Coordinator as
appropriate;
Assuring that personnel education on this QA/QI program takes place and is
documented in the personnel file;
Appointing sub committees or teams to work on specific issues, as necessary;
Providing an annual report to GAAA and GCHD Administration that addresses the
goals and achievements for the past year and the goals for the coming year for the
system.
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Investigations and Notifications Investigations of serious issues will begin within twenty-four hours upon notification of the
incident and will involve GCHD Risk and Safety, GCHD Human Resources, and GAAA
Administration. GAAA will also comply with their obligations to report serious incidents
involving patient care, to the Texas Department of State Health Services-EMS/Trauma
Services division.
Such reportable incidents include, but are not limited to, the following:
1. Medication errors resulting in serious injury;
2. Failure to provide treatment in accordance with GAAA Clinical Operating Guidelines
resulting in injury; or
3. Major medical or communications device failure, or other equipment failure or user
error resulting in injury or delay in response or treatment.
Additionally, the following must to be referred immediately (within 24 hours) to the
GAAA Medical Director, GCHD Human Resources and GCHD Risk and Safety for
review:
Esophageal Intubations (unrecognized);
Practicing medicine without a license;
Patient abandonment issues;
Patient care delays;
Situations that might immediately place patients in danger;
Medication errors potentially resulting in patient injury or death
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Appendix
This QA/QI Program for GAAA is a developing project. As such these forms should be
considered as evolving documents. As they are utilized, ways will be found to improve their
effectiveness and the ease in which they are filled out. Particularly early on in the program the
forms may be altered substantially or even replaced. Additionally other forms may be added
to facilitate short-term studies or evaluation projects. Suggestions are always welcomed and
should be forwarded to the GAAA QA Committee. The GAAA Medical Director and GAAA
Director must approve any changes.
ePCR REVIEW CHECKLIST PAGE 12
This checklist is to be utilized according to the criteria on page 6. GAAA may also utilize it for any
other calls at their own discretion.
ePCR REVIEW CHECKLIST CRITERIA PAGE 14
In order to provide consistency and to reduce subjectivity in run form reviews the criteria listed here
will be utilized.
DISPATCH REVIEW CHECKLIST PAGE 18
This checklist will be utilized to review dispatch tapes. Whenever possible the accompanying ePCR
will be reviewed at the same time.
DISPATCH REVIEW CHECKLIST CRITERIA PAGE 19
In order to provide consistency and to reduce subjectivity in tape reviews the criteria listed here will be
utilized.
GAAA QA COMMITTEE ADVISORY LETTER PAGE 21
If after initial review by the GAAA QA Coordinator it is decided further investigation is warranted, this
letter will be sent to the GAAA personnel involved. This is to give them the opportunity to provide
input.
GAAA EDUCATIONAL RECORD/SKILLS REVIEW PAGE 22
If at any time the GAAA QA Committee or GAAA Medical Director has assigned remedial training or
skills review to GAAA personnel, this form will be utilized to record the completion of those
requirements.
QUARTERLY REPORT FORM PAGE 23
GAAA QA Coordinator will complete this form and provide a copy of it to the appropriate Hospital QA
Committee within 30 days after the quarter has ended. These statistics will be utilized to help them
formulate and track goals and trends in EMS if needed.
GALVESTON AREA AMBULANCE AUTHORITY
QUALITY ASSURANCE PROGRAM
ELECTRONIC PATIENT CARE REPORT (EPCR) REVIEW CHECK LIST
Check List Criteria must be utilized when reviewing a EPCR using this form.
[1] AMB #: ___________ [2] UNIT#: _______________________ [3] DATE/TIME OF CALL: _______________________________
[4] TC: ____________________________________________________________________ [5] EMP. # : _________________________
[6] EMT: __________________________ EMP.#: _____________ EMT: __________________________ EMP.#:_____________
EMT: __________________________ EMP.#: _____________ EMT:__________________________ EMP.#:_____________
[7] Reviewed by: [ ] GAAA QA Coordinator Name: ________________________ Date: ____________________
[ ] GAAA QA Committee Name: ________________________ Date: ____________________
[ ] GAAA Medical Director Name: ________________________ Date: ____________________
[ ] Other ______________________ Name: ________________________ Date: ____________________
[8] Priority: ___________________________________ [9] Nature of Call: _________________________________________________
[10] Response Time: _______________ [11] On-Scene Time: ____________ [12] Extenuating Circumstances: [ ] Yes [ ] No
[13] If Yes, explain: ______________________________________________________________________________________________
[14] Age of Patient: _______ [15] Gender: [ ] F [ ] M [16] Patient Care Level: [ ] BLS [ ] Intermediate [ ] Paramedic
[17] Pt. Transported: [ ] Yes [ ] No If No, explain: ________________________________________________________________
A. DOCUMENTATION S= Satisfactory I= Improvement Needed A = Absent NA= Not Applicable
S I A NA S I A NA
[18] Run Info. (Date, Serv., Unit) [27] Treatment
[19] Pt. Info. (Name, Address, Age, MD) [28] Outcome/Results of Treat.
[20] Crew/Times [29] Observation Continued
[21] Reason for Call/ Clin. Impr. [30] Glasgow/Trauma Scores
[22] Allergies Noted [31] Vital Signs (Repeated?)
[23] Medications - Current [32] Procedures/Medications
[24] Past Medical History [33] Signatures
[25] History of Present Illness [34] Medical Control Physician
[26] Physical Exam Findings [35] Other: _________________
[36] Comments: _________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
B. CLINICAL AUDIT A= Acceptable/Appropriate I= Improvement Needed U= Unacceptable/Inappropriate
RFI = Requires Further Investigation NA= Not Applicable
A I U RFI NA A I U RFI NA
[37] Response Time [43] Treatment/Procedures
[38] Scene Time [44] Policy Adherence
[39] Dispatch of BLS/ALS [45] Overall Documentation
[40] Utilization of BLS/ALS [46] Overall Performance
[41] Assessment [47] Other:
[42] Trauma Team Activation [48] Other:_________________
[49] Comments: _________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Page 1 of 2 [ ] Hold for QA Committee Review
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C. SKILLS LOG No credit will be given for any skill that was not clinically indicated according to Treatment Protocols. Check the
“NI” (Not Indicated) column if this was the case.
Procedure EMT Performing Skill # Attempts # Successes NI
[50] Glucometer
[51] IV
[52] Rhythm Interpretation
[53] EKG (attach copy)
[54] ETT
[55] External Pacing
[56] Defibrillation
[57] Medication Admin. Med 1: Med 2: Med 3: Med 4:
[58] Intraossious Infusion
[59] Needle Chest Decompression
[60] Quick Trach
[61] Other:
[62] Comments: _________________________________________________________________________________________________
______________________________________________________________________________________________________________
[63] D. NOTES ______________________________________________________________________________________
_______________________________________________________________________________ [ ] see attached pages
[64] E. ACTION TAKEN BY GAAA QA COORDINATOR [ ] notification only [ ] see attached pages
___________________________________________________________________________________________________
___________________________________________________________________________________________________
[65] F. ACTION TAKEN BY QA COMMITTEE [ ] notification only [ ] see attached pages
___________________________________________________________________________________________________
___________________________________________________________________________________________________
[66] G. ACTION TAKEN BY EMS MEDICAL DIRECTOR [ ] notification only [ ] see attached pages
___________________________________________________________________________________________________
___________________________________________________________________________________________________
[67] H. ACTION TAKEN BY GAAA DIRECTOR [ ] notification only [ ] see attached pages
___________________________________________________________________________________________________
___________________________________________________________________________________________________
[68] I. FOLLOW-UP REQUESTED [ ] none [ ] see attached pages
___________________________________________________________________________________________________
___________________________________________________________________________________________________
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GALVESTON AREA AMBULANCE AUTHORITY
QUALITY ASSURANCE PROGRAM
ELECTRONIC PATIENT CARE REPORT (EPCR) REVIEW CRITERIA
1. # of transporting ambulance.
2. Unit
3. Date in MM/DD/YY format AND time in AM/PM or military time.
4. Name of Team Captain.
5. EMP # of Team Captain.
6. Additional EMTs. If there are more than four fit them in above #7.
7. Check off as reviewed and fill in.
8. Priority – this is only if it was recorded, not if it was correct.
9. Nature of Call (not what it was dispatched as but what it really was).
10. This is how long it took until the ambulance signed on. Subtract “Responding” from “Dispatched” times.
11. This is how long the ambulance was on-scene. Subtract “Leave Scene” from “On Scene”.
12. If any of the times are excessive and there is an explanation in the narrative, check “Yes”, otherwise check “No”.
13. If you check “Yes” to #12 write the explanation here.
14. Age of Patient.
15. Gender of Patient.
16. Check the highest level of care provided.
17. Check “Yes” if the patient was transported, “No” if not. If “No” explain why (i.e. “refusal”, “no patient found”).
Section A. Documentation. QA Review for this section involves whether or not the run form was filled out completely,
correctly and legibly.
“S” = the item was documented completely, correctly and legibly.
“I” = the item is incomplete, unclear or illegible.
“A” = the item is missing altogether.
“NA” = the item is not applicable for this run.
18. Was the Date, Unit, Personnel, etc. recorded?
19. Were the patient’s Name, Home Address, Town, State, Zip and Incident Address filled out correctly? Was
Responsible Party/Employer fill out or marked NA? Was the Priority, Age, DOB, Gender and Local MD filled out
correctly?
20. Was the crew selected correctly? Are all times listed and legible?
21. Was the Reason for Call filled out correctly? Does the Clinical Impression accurately reflect the patient’s
condition?
22. Does the Allergies box have either NKDA or listed allergies?
23. Does the Medications box have either unknown, denied, or listed medications? Is the spelling close enough so that
other medical professionals will know what the medications are?
24. Does the History box have listed history or denies? If there is a listed history, is it clear and complete?
25. Does the narrative or assessment clearly record the patient’s history of the present illness or injury?
26. Does the narrative or assessment clearly record the results of the physical exam?
27. Does the narrative or flow chart clearly record all treatment given?
28. Does the narrative, assessment, or flow chart clearly record the outcome and/or results of all treatment given?
29. Does the narrative, assessment, or flow chart clearly record that the patient was continually observed and what
those observations were?
30. Is an accurate Glasgow Coma Scale and Revised Trauma Score recorded?
31. Were vital signs recorded? Where they repeated every 5 minutes for critical patients and every 15 minutes for
other patients?
32. Were all medications and procedures listed in the “Medication and Treatment Therapy” box including O2, IV,
medications, ETT, blood glucose and bloods drawn?
33. Did the Medical Control Physician sign the form if orders were requested?
34. Did the personnel that completed the form, the patient/patient representative, and the RN or MD that received the
patient sign the form?
35. Is there anything else absent such as Data Collection, Communications, Disposition or any thing else?
36. Comments: Clarify any items that received an “I” or a “U” rating. Attach extra sheets if necessary.
B. Clinical Audit QA review for this section involves what actually happened on the run. In general the following will
apply:
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“A” = the actions taken for the selected topic were acceptable or appropriate according to industry standards,
GAAA protocols or GAAA policies.
“I” = the item was performed but should be reviewed for circumstances or could be improved.
“U” = the actions taken for an item were outside of industry standards, GAAA protocols or GAAA policies. This
would include omission of an action that should have occurred.
“RFI” = there is not enough information on the run form to make a determination.
“NA” = the item is not applicable.
37. Response time: (the amount of time from dispatch to the ambulance going enroute)
Personnel on duty in the station: “A” = <1 min., “I” = > 1 min. but < 3 mins., “U” = > 3 mins.
Personnel on duty not in the station: “A” = <1 mins., “I” = >1 mins but < 3 mins., “U” = > 3 mins.
Personnel on duty in bed after 2200 hrs: “A” = <2 mins., “I” = > 2 mins but < 4 mins., “U” = > 4 mins.
38. Scene time: (the amount of time the ambulance is on-scene – not EMTs)
Trauma – “A” = < 10 mins.,
“I” = >10 mins but < 20 mins. without extenuating circumstances,
“U” = >20 mins. without extenuating circumstances.
Extenuating circumstances may be anything from a difficult extrication to an uncooperative patient but must be
documented.
Medical – “A” = < 15 mins., (<10 if only BLS)
“I” = >15 mins but < 20 mins. without extenuating circumstances, (>10 but <20 if only BLS)
“U” = > 25 mins. (>20 if only BLS)
Rate depends on whether or not paramedic level care was delivered on scene. Extenuating circumstances are the
same as for trauma.
39. Dispatch of BLS/ALS (non-emergency transport):
“A” = Based on the “Reason for Call” the call was BLS and dispatched as BLS or was ALS and dispatched as
ALS, or as soon as sufficient information was obtained ALS was requested or cancelled appropriately.
“I” = ALS was requested when the call did not fit ALS dispatch criteria or was dispatched later than it should have
been.
“U” = ALS should have been dispatched based on ALS dispatch criteria but was not.
40. Utilization of BLS/ALS skills: Based on who performed the skills listed in the Narrative, Vital Signs box, and
Medications and Treatment box.
“A” = Appropriate division of tasks, including driving, based on personnel level and the patients condition (For
example if there was a B, an I and a P in the back of the ambulance on an ALS run, the B is doing vitals, the I the
IV and the P the meds).
“I” = Tasks are not divided evenly but care is delivered appropriately according to EMT level.
“U” = Care is not delivered appropriately according to EMT level (I.e. A paramedic drives with only a basic in
back on an ALS call).
41. Assessment:
“A” = The scene and the patient were assessed promptly, thoroughly and appropriately. The documented vitals and
other findings support the diagnosis (or at BLS level support the treatment).
“I” = The assessment was delayed or incomplete without extenuating circumstances.
“U” = An assessment was not performed or a BLS assessment was performed when ALS was present and an ALS
assessment should have been performed.
42. Trauma Team Activation:
“A” = The Trauma Team was activated appropriately and timely.
“I” = The Trauma Team was activated later than it should have been or was activated when the call did not fit the
criteria for activation.
“U” = The Trauma Team was not activated when the call fit the criteria for activation.
43. Treatment/Procedures:
“A” = The treatment/procedures were complete, performed correctly and appropriately based on the patients
condition, GAAA Protocols and EMT level. The appropriate medications were given in the appropriate dose.
Medical Control orders were followed (if requested).
“I” = Treatment/procedures were provided that were not according to GAAA protocols but did not harm the
patient (i.e. c-collared and back boarded a patient that did not meet the criteria for c-spine immobilization). Minor
treatment was omitted that should have been provided but the omission would be unlikely to harm the patient.
“U” = Treatment/procedures/medications were provided that were not according to GAAA protocols and could
have harmed the patient or were omitted when they should have been provided and the omission could have
harmed the patient. Even if the patient was not actually harmed, an incident that meets this criteria should still be
marked as “U”.
44. Policy Adherence:
“A” = GAAA policies that would apply to the run were adhered to.
“I” = Minor policies were not followed but the omission would be unlikely to harm the patient or be detrimental to
the service.
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“U” = GAAA policies that should have been follow were not and the omission could have harmed the patient or
have been detrimental to the service.
45. Overall Documentation:
“A” = The overall documentation was sufficient to become an reliable part of the patient’s medical record and
correctly indicates information and language needed for billing purposes.
“I” = The overall documentation should be reviewed for circumstances or improved.
“U” = The overall documentation is not complete enough to become a reliable part of the patient’s medical record.
46. Overall Performance:
“A” = The overall performance of EMS was consistent with industry standards, GAAA protocols and
GAAA/GCHD policies.
“I” = The overall performance should be reviewed for circumstances or could be improved.
“U” = The overall performance was not consistent with industry standards, GAAA protocols, and GAAA/GCHD
policies.
47. Other: Used to assess the performance of EMS as the result of any unusual occurrences.
48. Other: Used to assess the performance of EMS as the result of any unusual occurrences.
49. Comments: Clarify any items that received an “I” or a “U” rating. Attach extra sheets if necessary.
C. Skills Log QA review for this section involves recording which skills EMTs performed and if they were successful. NO
credit will be given unless the skill was clinically indicated according to Region V Treatment Protocols.
50. Glucometer:
Attempt = Stick is touched to a blood droplet.
Successful = An accurate reading is obtained.
Unsuccessful = The machine malfunctions.
51. IV: (if 2 EMTs attempted IVs put the 2nd
EMT in the “Other” box)
Attempt = Any time the needle pierces the skin.
Successful = The line is able to be run. Bloods do not have to be drawn to be considered successful
Unsuccessful = Any attempt where the line will not run.
52. Rhythm Interpretation: Copy should be attached to run form
Attempt = Obtain or are given a rhythm
Successful = The rhythm is interpreted correctly.
Unsuccessful = The rhythm is interpreted incorrectly or rhythm is not attached.
53. 12-Lead EKG: Copy should be attached to run form.
Attempt = Placement of electrodes.
Successful = Proper placement of the electrodes, legible printing of the 12 lead tracing and correct interpretation.
Unsuccessful = Improper placement of the electrodes, illegible printing of the 12 lead tracing, incorrect
interpretation or machine malfunction.
54. ETT: (if 2 EMTs attempted an ETT put the 2nd
EMT in the “Other” box)
Attempt = Any time a laryngoscope is positioned in the patient’s airway for the purpose of inserting an ETT.
Successful = The ETT is properly positioned with good breath sounds on either side and the patient is adequately
ventilated.
Unsuccessful = The ETT in positioned in the esophagus or bronchus or is inadequate to ventilate the patient.
55. External Pacing:
Attempt = Placement of the pads and attempting to pace in a demand or non-demand mode.
Successful = Proper placement of pads and the milliamps and rate were set according to protocol.
Unsuccessful = Improper placement of pads or machine malfunction.
56. Defibrillation:
Attempt = The pads are applied to the patient and the machine is turned on.
Successful = The machine works as intended and EMTs respond appropriately.
Unsuccessful = The machine malfunctions or EMTs fail to follow the directions of the machine.
57. Medication Administration: List each medication including BLS medications.
Attempt = The need for a particular medication was recognized and actions were taken to deliver it.
Successful = The patient received the proper dose of the proper medication by the proper route.
Unsuccessful = The medication was not given or was given the wrong medication, wrong dose, by the wrong route
or the medication was expired.
58. Intraossious Infusion:
Attempt = Any time the needle pierces the skin.
Successful = The line is able to be run.
Unsuccessful = Any attempt where the line will not run.
59. Needle Chest Decompression:
Attempt = Piercing the skin with the needle.
Successful = Catheter or device is properly positioned and release of pressure is noted.
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Unsuccessful = Catheter or device is improperly position.
60. Quick Trach:
Attempt = Piercing the skin with the needle.
Successful = Device is properly positioned and patient adequately ventilated.
Unsuccessful = Device was improperly positioned.
61. Other: List any other similar procedures
Attempt = An attempt was made to perform the procedure.
Successful = The procedure was successfully performed.
Unsuccessful = The procedure was not successfully performed.
62. Comments: Write any needed explanations needed for this section.
63. D. Notes: Write any additional notes needed. Check the box if there additional pages added from this section.
64. E. Action Taken By GAAA QA Coordinator: Check the first box if the Coordinator is notified but takes no
action. If action is taken describe it here.
65. F. Action Taken By QA Committee: Check the first box if the Committee is notified but takes no action. If
action is taken describe it here.
66. G. Action Taken By the EMS Medical Director: Check the first box if the Director is notified but takes no
action. If action is taken describe it here.
67. H. Action Taken By GAAA Director: Check the first box if the GAAA Director is notified but takes no action.
If action is taken describe it here.
68. I. Follow-up Requested: Check the first box if no follow-up is necessary, otherwise describe any follow-up
requested by any person.
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GALVESTON AREA AMBULANCE AUTHORITY
QUALITY ASSURANCE PROGRAM
DISPATCH REVIEW CHECK LIST
[1] AMB #: ___________ [2] CREW: _______________________ [3] DATE/TIME OF CALL: ____________________________
[4] Dispatcher (if known): _______________________________________________________________________________________
[5] Team Captain (if known): _____________________________________________________________ EMP. #: _________________
[6] Reviewed by: [ ] GAAA QA Coordinator Name: ________________________ Date: ____________________
[ ] GAAA QA Committee Name: ________________________ Date: ____________________
[ ] GAAA Medical Director Name: ________________________ Date: ____________________
[ ] Other ______________________ Name: ________________________ Date: ____________________
[7] Priority: _______ Based on: [ ] ePCR [ ] Tape [8] Nature of Call: ___________________________________________________
[9] Dispatched As: _______________________________________________________________ [10] Dispatch Time: _______________
[11] Extenuating Circumstances: [ ] Yes [ ] No [12] If Yes, explain: ___________________________________________________
[13] Age of Patient: _______ [14] Gender: [ ] F [ ] M [15] Patient Care Level: [ ] BLS [ ] Intermediate [ ] Paramedic
A. CLINICAL AUDIT A= Acceptable/Appropriate I= Improvement Needed U= Unacceptable/Inappropriate RFI = Requires Further Investigation NA= Not Applicable
A I U RFI NA A I U RFI NA
[16] Dispatch Time [22] Cancellation
[17] Quickest Amb. Dispatched? [23] Policy Adherence
[18] Problem & Directions Clear [24] Radio Reception
[19] Dispatch of BLS/ALS [25] Overall Performance
[20] Trauma Team Activation [26] Other:
[21] Dispatch of Add. Resources [27] Other:_________________
[28] B. NOTES ______________________________________________________________________________________
_______________________________________________________________________________ [ ] see attached pages
[29] C. ACTION TAKEN BY QA COORDINATOR. [ ] notification only [ ] see attached pages
___________________________________________________________________________________________________
[30] D. ACTION TAKEN BY QA COMMITTEE [ ] notification only [ ] see attached pages
___________________________________________________________________________________________________
[31] E. ACTION TAKEN BY EMS MEDICAL DIRECTOR [ ] notification only [ ] see attached pages
___________________________________________________________________________________________________
[32] F. ACTION TAKEN BY GAAA DIRECTOR [ ] notification only [ ] see attached pages
___________________________________________________________________________________________________
[33] G. FOLLOW-UP REQUESTED [ ] none [ ] see attached pages
___________________________________________________________________________________________________
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GALVESTON AREA AMBULANCE AUTHORITY
QUALITY ASSURANCE PROGRAM
DISPATCH REVIEW CRITERIA
If possible prior to reviewing dispatch tapes or transcripts have the accompanying EPCR available.
1. # of transporting ambulance.
2. Personnel.
3. Date in MM/DD/YY format AND time in AM/PM or military time.
4. Name of Dispatcher (if available).
5. Name and # of EMT Attendant in Charge (if known).
6. Check off as reviewed and fill in.
7. Priority based on the EPCR if available otherwise based on the tape. Check which is used.
8. Nature of Call (not what it was dispatched as but what it really was if known).
9. Dispatched As (what the dispatcher said the call was)
10. Dispatch Time. Subtract “Dispatched” from “Call Received”.
11. If any of the time is excessive and there is an explanation in the narrative, check “Yes”, otherwise check “No”.
12. If you check “Yes” to #12 write the explanation here.
13. Age of Patient.
14. Gender of Patient.
15. Check the highest level of care provided.
A. Clinical Audit 16. Dispatch time: (the amount of time when the call was received until the call was dispatched)
“A” = < or = to 1 min., “I” = > 1 min. but < 3 mins., “U” = > 3 mins. without extenuating circumstances.
17. “A” = The ambulance that could likely get to the patient the fastest was the ambulance that was dispatched.
“I” = Possibly another ambulance could have gotten there faster.
“U” = Clearly another ambulance could have gotten there faster.
18. “A” = The problem (reason for dispatching an ambulance) and directions to the location were as clear possible
based on what the caller gave and/or dispatch was able to assist finding the location.
“I” = The problem and/or directions could have been clearer but responders had sufficient information to respond
appropriately and were able to find the location without delay.
“U” = Little or no patient information that resulted in inappropriate omission or dispatch of resources and/or
directions were unclear resulting in a delayed response.
19. Dispatch of BLS/ALS:
“A” = Based on the “Reason for Call” the call was BLS and dispatched as BLS or was ALS and dispatched as
ALS, or as soon as sufficient information was obtained ALS was requested or cancelled appropriately.
“I” = ALS was requested when the call did not fit ALS dispatch criteria or was dispatched later than it should have
been.
“U” = ALS should have been dispatched based on ALS dispatch criteria but was not. “U” = >10 mins. without
extenuating circumstances.
Extenuating circumstances may be anything from a difficult extrication to an uncooperative patient but must be
documented.
20. Trauma Team Activation:
“A” = The Trauma Team was activated appropriately and timely.
“I” = The Trauma Team was activated later than it should have been or was activated when the call did not fit the
criteria for activation.
“U” = The Trauma Team was not activated when the call fit the criteria for activation.
21. Dispatch of Additional Resources:
“A” = Additional EMS resources (EMTs, mutual aid ambulances, specialized equipment) were dispatched
appropriately and timely.
“I” = Additional EMS resources were dispatched later than they should have been or was dispatched when the call
did not fit the criteria for requesting those resources.
“U” = Additional EMS resources should have requested but were not.
22. Cancellation:
“A” = EMS resources (additional EMTs, ALS, ambulances) were cancelled timely and appropriately.
“I” = EMS resources were not cancelled or cancelled after they could have been.
“U” = EMS resources were not cancelled when they clearly should have been resulting in an unnecessary lights
and siren response.
23. Policy Adherence:
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“A” = Dispatch policies and protocols, including the “5 Minute Rule” and MCI protocols were adhered to when
applicable.
“I” = Dispatch policies and protocols were adhered to but later than they should have been or minor policies where
not adhered to but did not result in a delay of care or injury to a patient.
“U” = Dispatch policies and protocols were not adhered creating a potential for delaying care or injuring a patient.
24. Radio Reception:
“A” = All radios could be clearly heard.
“I” = One or more radios experienced poor reception but it did not adversely affect care.
“U” = One or more radios experienced poor or no reception resulting in the potential for adversely affecting care.
If “I” or “U” is noted for this issue, in the comments section indicate which radio(s) experienced the problem if
ascertainable.
25. Overall Performance:
“A” = The overall performance of Dispatch was consistent with industry standards, Statewide protocols, Region V
and service policies.
“I” = The overall performance should be reviewed for circumstances or could be improved.
“U” = The overall performance was not consistent with industry standards, Statewide protocols, Region V and
service policies.
26. Other: List any other issues pertinent to the call. It could be something that was done well that should be pointed
out as well as something that needs improving.
“A” = The item was consistent with industry standards, Statewide protocols, Region V and service policies.
“I” = The item should be reviewed for circumstances or could be improved.
“U” = The item was not consistent with industry standards, Statewide protocols, Region V and service policies.
27. Other: List any other issues pertinent to the call. It could be something that was done well that should be pointed
out as well as something that needs improving.
“A” = The item was consistent with industry standards, Statewide protocols, Region V and service policies.
“I” = The item should be reviewed for circumstances or could be improved.
“U” = The item was not consistent with industry standards, Statewide protocols, Region V and service policies.
28. B. Notes: Write any additional notes needed. Check the box if there additional pages added from this section.
29. C. Action Taken By GAAA QA Coordinator: Check the first box if the Coordinator is notified but takes no
action. If action is taken describe it here.
30. D. Action Taken By GAAA QA Committee: Check the first box if the Committee is notified but takes no action.
If action is taken describe it here.
31. E. Action Taken By the GAAA Medical Director: Check the first box if the Director is notified but takes no
action. If action is taken describe it here.
32. F. Action Taken By GAAA Director: Check the first box if the Director is notified but takes no action. If action
is taken describe it here.
33. G. Follow-up Requested: Check the first box if no follow-up is necessary, otherwise describe any follow-up
requested by any agency.
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GAAA QA COMMITTEE LETTER
Dear __________________________________,
As part of the Galveston Area Ambulance Authority Quality Assurance/Quality Improvement
program, we regularly review EMS runs including ePCR’s and dispatch tapes. The following case has
raised some questions with the GAAA QA Coordinator during preliminary review:
UNIT: EPCR#: DATE: TIME: ______
Personnel Appearance before GAAA QA Committee requested? Yes NO
Of specific concern: __________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
The QA Committee would appreciate your review of the case and respond to the Committee on this
issue.
Our goal in reviewing cases is to assure the quality of EMS care as well as provide continuing
education to GAAA pre-hospital care providers. Therefore, the focus of EMS quality assurance should
be an attempt to educate providers to their fullest potential.
Your written incident report should include your perceptions, actions, pertinent details, and should be
received in this office within four (4) days.
If you are required to appear before the GAAA QA Committee to discuss this case, contact the GAAA
Quality Assurance Coordinator so a specific time may be scheduled.
Upon receipt of all material, the QA Committee will resolve this case and send you notification of the
resolution.
Sincerely,
____________________________
GAAA Quality Assurance Coordinator
Date Sent:
Date Due:
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GAAA EDUCATIONAL RECORD/ SKILLS REVIEW
Name: _________________________________ EMP. #: _________________________
As a result of action taken by the GAAA QA Committee, you are required to complete the following
educational activities or skills review:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
It is hereby certified the above individual has satisfactorily completed the educational activities or
skills review as outlined.
Date Time Location Skill(s)/ Class Completed Total Hours
GAAA Training Coordinator
GAAA QA Coordinator
GAAA Personnel Date
Comments/Notes/Preceptor Findings:
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