PERFORMANCE IMPROVEMENT OVERVIEW
According to the Institute of Medicine (IOM) (1990), healthcare quality is defined as the “degree to which health services for individuals or populations increase the likelihood of desired health outcomes and are consistent with the current professional knowledge”. Performance improvement (often referred to as quality assurance or quality improvement) initiatives aim to assure the effective and efficient delivery of healthcare services.
While many methods and programs exist to analyze quality, in healthcare we are primarily concerned with countering underuse (not providing an intervention), overuse (providing an unnecessary intervention), and misuse (improper provision of care).
There are multiple perspectives from which we can explore the concept of quality. Utilizing a system-based approach that explores structures, processes, and outcomes (Donbedian, 1966).
STATE PERFORMANCE IMPROVEMENT MANDATE
Section 12 VAC 5-31-600 of the Virginia Emergency Medical Services Regulations requires all EMS agencies to participate in Performance Improvement review programs. The Office of Emergency Medical Services requires that the Southwest Virginia EMS Council coordinate a regional performance improvement plan and to provide a schedule and topics for quarterly, region-wide PI projects to be conducted by the Council and individual EMS agencies. OEMS also requires that the Council aggregate the findings of the individual EMS agencies for use by the region's committees and reporting to OEMS.
DEVELOPING AN AGENCY PI PROGRAM
EMS agencies should implement processes to review their own effectiveness and efficiency. PI programs should be established in conjunction with the agency’s Operational Medical Director. As part of a continuous PI review program, an EMS agency PI program should include ongoing monitoring of all facets related to patient care, communications, and all aspects of transport operations. At a minimum, agencies should review a medical issue, trauma-triage issue, and system issue each quarter. Records should be maintained for review during your annual agency inspection.
The Council has developed a regional PI Plan as well as a generic PI template that can be used by licensed EMS agencies (linked below). Your participation in the regional PI program OR your own internal PI review ensures compliance with 12 VAC 5-31-600 as defined in the Regional Performance Improvement Plan(s) (Revised 2007).
For instructions on submitting previous quarter PI data, please contactField Coordinator Josh Wilkinson.
PERFORMANCE IMPROVEMENT REFERRAL
In an effort to improve overall patient care within our region, the regional performance improvement committees (EMS and Trauma) will review any complaints concerning patient care submitted by agencies, hospital personnel, or community members. A recommendation will be made in accordance with the regional PI and TPI plans and may be referred as appropriate to the agency OMD and the OEMS Program Representative. The committees will also review any compliments of the regional EMS system or specific agencies. Use this form to submit any compliments or complaints of the regional EMS system. For further questions regarding Performance Improvement Referral, contact Field Coordinator Josh Wilkinson.
document PI Referral Form Fillable
OTHER PI RESOURCES
We are attempting to get more agencies on board with using Biospatial. If possible, when you are reviewing agencies' improvement ideas, can you mention Biospatial? It is a great way for agencies to see what type of calls they are receiving and where. This would allow them to evaluate the manpower and materials needed at a particular time of day and/or week. In addition, it can determine how fast they can get to calls if used properly. Biospatial can also benchmark an agency's performance against other agencies in their county. It is important to see where you stand versus your competition. For more information, contact Barry Reeves at the Virginia Office of EMS.
- A Leadership Guide to Quality Improvement for Emergency Medical Services Distributed by the National Highway Traffic Safety Administration
- What is Quality Improvement? (Presentation of Quality Improvement from Duke University)
- Improving Quality in EMS National Association of EMS Physicians Prehospital Systems and Medical Oversight National Association of EMS Physicians