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EMS EduCast/EMS Garage #48 Quality

Posted Oct 04 2009 11:13pm




Again returning to the EMS Garage post with Mickey S. Eisenberg, MD on resuscitation, [1] the rest of the episode was great. One of the points brought up was, at about 52 minutes in, Buck Feris mentions a quality assessment/improvement method in a system, that has a supervisor respond to debrief the crew after every arrest. Reviewing what went right and what went wrong.

Dr. Mickey S. Eisenberg earlier had talked about methods of improving outcome and the approach of reviewing every unsuccessful resuscitation by asking, Why wasn't this patient resuscitated?

These are excellent approaches. If we are not reviewing our calls, how do we expect to improve? I think that both of these approaches are still too limited. We should review all calls that fall into certain categories. For example, all cardiac/potentially cardiac calls, all respiratory calls, all calls involving any level of pain, et cetera. Maybe not right after the call, but as soon as is practical.

In my opinion, people who are opposed to continually improving patient care are not needed in EMS.

What kind of ignorance is needed to claim that we should not be improving our care of patients? Real medicine is about continually improving patient care.

Dr. Eisenberg goes on to make an essential point about a method used to improve quality. Audio recordings of cardiac arrests by the defibrillator. He states,


We have found that immensely valuable. We've used it in our system from day one. We've recorded virtually every cardiac arrest event, with not only the rhythm, but with the voice. That has been a very valuable tool, to reconstruct for educational purposes, what exactly was going on in the resuscitation and when. Because, without it you can't really tell when there are gaps in CPR, you can't even tell when ventilations are occurring, you can't tell reasons why there was the delay in this or that.

And if it's done for the purpose of education and never for the purposes of discipline. We've never, ever, used these tapes for disciplinary reasons. They've always been used for education. You can learn an awful lot, and begin to piece together what went on.



If we want to improve quality, we need to make it safe for people to bring up and discuss mistakes. If the employees are afraid of punishment for raising concerns about things that went wrong, we will never learn about many of the problems in the system. We need more people in EMS, who understand this.

Again, in my opinion, people who are opposed to continually improving patient care are not needed in EMS.


Footnotes:


^1EMS Garage Special Edition: How to Improve Survival from Sudden Cardiac Arrest Episode 48
EMS Garage
Links to broadcast and downloads.

A cooperative broadcast between EMS Garage (above) and EMS EduCast (below):

How to Improve Survival from Sudden Cardiac Arrest: EMS Educast Episode 27


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