Developing a Comprehensive QA ProgramDavid A. Miles, Ph.D.

Welcome!Thank you for choosing to attend this session!

Together in this hour we will accomplish the following items:• Give you some examples and tools that you can use to develop a QA program

in your organization • Review how our organization began developing a comprehensive QA

program• Look at pitfalls and items to avoid so you can learn from some of our

mistakes• Answer any questions and exchange great ideas

HAVE SOME FUN!!!

“If learning isn’t fun,

you’re doing it wrong!”

Gary J. Confessore, Ed.D.

Professor Emeritus

The George Washington University

Format for the Session…

• Case Study

• Interactive

• Q&A at the end

Tell me a little bit about you?What type of EMS organization do you represent?

What role do you fill in that organizations?

What would be most helpful for you in today’s presentation?

Our QA Journey…• Previously hit or miss…

• Not systematic

• Not process oriented

• Chiefly complaint or issue driven with some periodic random QA

First things First…

Documentation Guidelines Served as “Standard Work” for Crews to utilize for their documentation.

…also “standard work” for those doing the QA as a guide

• Format:• Began with the very first tab in FieldBridge and went step-by-step with what to

place in what box• Simple for the new employee to use and follow• Choices based on our agency

Started with the “Why”

Stress to our EMS providers WHY our documentation was so important

Ultimate Goal for Program…

Improved Clinical Outcomes

Documentation Guidelines

Documentation Guidelines• Step-by-step through the “tabs”• Covered the Narrative Portion separately • Examples at the end of the document

• Specific Reporting Requirements • Vents, medication drips, equipment, etc.

• Many involved in the process of creating the guidelines• Field providers, Supervisors / Field Training Officers, Managers• Billing Department

• Heavily influenced by…• Info from Page, Wolfberg, & Worth • The Missing Protocol: A Legally Defensible Report (1999 - Denise Graham )

What did we want to accomplish?• Improved Clinical Outcomes / Patient Care

• Improved Clinical Documentation • Legal and Billing

• Compliance with State QA Guidelines• West Virginia• Maryland• Virginia

• ONE PROCESS (not three)

Process that we developed

What was the process?

…what do you mean you can’t read all of that from the back row?

Let’s take a closer look…

QA Process

QA Process

QA Process

Implementation (behind the scenes)• QA “auditors” identified

• Field Training Officers & Field Supervisors

• Process to capture and distribute information• Report Writer 2.0

• Could have entitled the session “How to build a QA process while not knowing ANYTHING about the QA/QI module in ImageTrend”

• QA Spreadsheet on our internal SharePoint Site• Created a site within our corporate SharePoint for the FTO’s/Supervisors specific to QA• HIPPA Compliant – no access to site from crews, etc. • All with access have signed ImageTrend Confidentiality Agreement

• Tools for Auditors• Fillable PDF form for auditing run sheets

Standardize as much as possible• Reports ran every week on Monday

• Monday through Sunday of previous week

• Know where to go to find their weekly assignment• SharePoint site via Spreadsheet• No more than 5 QA audits per week per person

• Standardize• Forms (QA Audit Form)• Naming convention for saving work

• Training for all auditors • One-day initial training• On-going coaching by Referral Auditors

Implementation

QA Audit Review Form

Everything in-between goes step-by-step through the PDF PCR

QA Audit Review Form (First Page)

QA Audit Review Form (First Page)

QA Audit Review Form (Last Page)

QA Audit Review Form (Last Page)

Reports that we run

Reports that we run

Reports that we run

Reports that we run

Disseminating the Weekly QA (OLD)

Original configuration with only 2 FTO’s doing QA

Disseminating the Weekly QA (OLD)

Once we added multiple FTO’s and Supervisors doing QA

Prepare to be OVERWHELMED!

Disseminating the Weekly QA (NEW)

Disseminating the Weekly QA (NEW)

BIG Lesson: Divide out the work

Addition of Referral Auditors

Addition of Referral Auditors

Addition of Referral Auditors

Tracking ComplianceTHREE MAIN FUNCTIONS for Referral Auditors:

Follows up with Field Staff on QA notes that they were copied on…

Randomly reviews the QA audits to ensure quality and provide feedback (i.e.: especially those with no QA notes to providers… ever)

Tracks delinquent QA audits

Results?

Results?

By tracking the problem we saw a DRAMATIC improvement in number of QA notes sent for inadequate Narratives

Now where are we in the process…Status Post: ICD-10 (Looking to revamp our Documentation Guidelines)

Shuffle the deck with our Referral Auditors (experts, leaders, role-models)

Adding new FTO’s

New training and processes starting with Referral Auditors

New 1 day training for all

Start looking to improve again

Lessons Learned…• WOW – it sure would be nice to know how to

REALLY utilize the automatic reporting and features in the QA/QI Module• Planning is great but…• Implementation can be rough - EXPECT

resistance from ALL parties involved• “I’m NOT using the CHART format, sir!”

• Time Consuming behind the scenes• The more buy-in from QA officers beforehand

the better• Keep plugging away at it… it does get better.

HINT!!!!

Q & A…

Remember… always give credit where credit is due!