Quality and Patient Safety
Everyone in healthcare strives to provide safe and effective care. However, the process of identifying areas for improvement and implementing change can be challenging. If you’ve struggled with this process, you’re not alone. There are many agencies in Wisconsin that do not have a formal quality improvement program.
Our medical directors have expertise in implementing quality management programs, as well as a prehospital informaticist to assist with data analysis, visualization, and statistical methods of quality control.
Just Culture
To err is human, but errors can have serious consequences for patients and providers. While we strive to achieve zero harm, we must also acknowledge the reality that mistakes will occur.
One of the most important and difficult changes for an organization to make while striving for high reliability is to develop a culture of safety. For this type of culture to exist, individuals at all levels of the organization must feel psychologically safe to share concerns and mistakes, without the fear of retribution.
The Just Culture approach acknowledges that many mistakes are not caused solely by an individual’s actions, but by failures of the system. For example, a medication error might initially appear to be the fault of a single provider’s actions, but may also be related to unclear labeling on a medication vial. Correction of the labeling is more likely to prevent future errors than reprimanding the provider who made the mistake. Opportunities for improvement are most plentiful when individuals feel safe reporting incidents that occur.
Our medical directors embrace Just Culture principles and foster a culture of safety.
Active EMS Quality Improvement Projects
The Problem
EMS providers don’t have regular access to scales, as other healthcare providers in hospitals and clinics do. This is a systematic problem that limits the ability of EMS providers to accurately assess the weight of pediatric patients. Errors in weight estimation are a risk factor for medication errors.
Our Approach
Since 2021, we have maintained a quality improvement registry related to pediatric weight estimation. We have used this data to assess the accuracy of weight estimation across the UW EMS Consortium and identify particular methods of weight estimation that are most accurate across different age groups. Through an educational campaign and implementation of the algorithm, we have successfully reduced the rate of guessed weights and improved the overall accuracy of weight estimation in the system. Several UW EMS Consortium agencies are currently trialing newly developed scales for EMS stretchers.
The Problem
Airway management is one of the most essential and lifesaving skills that EMS providers perform. However, some advanced techniques, such as placing breathing tubes, are also associated with risks. It is well-established that these risks can be mitigated with comprehensive quality improvement programs.
Our Approach
We recognized that the amount of data available in the EMS electronic health record was insufficient for answering important questions about airway management. To help better understand and improve how we manage airways, we used an iterative, user-centered approach to design a comprehensive airway improvement registry. As part of our airway management program, our medical directors also review video recordings of airway management attempts and provide direct, formative feedback to EMS providers. Since the registry was launched in 2024, we have successfully enrolled more than 90% of airway cases across the UW EMS Consortium. Our airway improvement program is among the most comprehensive programs of its type.
Salicyna, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons
The Problem
ST-elevation myocardial infarction (STEMI) is a time-sensitive and very serious type of heart attack that can be diagnosed by EMS providers with an electrocardiogram (ECG). When EMS providers identify and prenotify the hospital that a patient has a STEMI, they receive more timely intervention at the hospital and achieve better outcomes. To ensure that the entire timeline from STEMI identification to definitive treatment is as efficient as possible, it is necessary to measure each interval in the patient’s care continuum, including prehospital and hospital components.
Our Approach
We developed a quality improvement registry and established a partnership between UW Health and SSM St. Mary’s Hospital to gather data on patients with STEMI who were treated by UW EMS Consortium agencies. Using this registry, we can help ensure that EMS is doing its part to get patients to definitive intervention within 90 minutes of first contact, consistent with American Heart Association performance targets. As part of our program, we also monitor the proportion of eligible patients receiving ECGs and the timeliness with which the ECGs are acquired, which are essential to identifying all possible cases of STEMI.
The STEMI chain of survival includes EMS evaluation and treatment. Reference