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Quality Improvement Initiatives for Patient Advocacy

Lindsay Alexander | May 22, 2018

As the Service Quality and Patient Safety Officer, Nicola Little has been instrumental in the implementation of beneficial programming and processes for the paramedic program at Winnipeg Fire Paramedic Service (WFPS). In conjunction with the Medical Director’s Office, she continues to evaluate multiple avenues of information in order to monitor overall system and paramedic performance. Because of her accomplishments, she’s a 2018 ZOLL Pulse Award winner. Here’s why:


The Benefits of Outcome-Focused QI for Patients

Using RescueNet ePCR in consultation with field supervisors and paramedics, Nicola identifies gaps in protocol and policy knowledge and makes recommendations, establishes corrective action plans and introduces new operational procedures to improve overall efficiency and patient safety. All service QI initiatives are outcome focused, driven to improve patient outcomes, patient safety and patient care.

As a specific example, Nicola has recently completed work on an improvement initiative related to acute coronary syndrome care. Through data review, significant numbers of cases were identified where first medical contact to 12 lead ECG did not occur in under the 10 minute time window outlined in protocol test. Nicola established improvement initiatives with recommendations that protocol changes reflect 12 lead acquisition to be concurrent with initial assessment and history taking and include criteria for 12 lead criteria acquisition in atypical patients. Following completion, protocol compliance was found to have increased with ACS and STEMI cases having compliance ratings of 83 percent and 92 percent respectively, marking a 10 percent improvement in compliance for each protocol.


How Innovation Can Improve Documentation & Billing Processes

In terms of innovation, Nicola has several accomplishments. These include improvements to crew sign-in and ePCR document management practices, patient safety and event reporting, patient safety learning summaries, and risk management associated with patient refusals/non transport calls. Nicola streamlined the sign-in and document management process for ePCR, resulting in:

  • Greater ease in documents being shared between ambulance and fire paramedics within WFPS.
  • A marked improvement in the ePCR document flow, which lead to further improvement and an overall reduction in the time for ambulance billings to be issued. Prior to these changes the ability to issue timely ambulance invoices was identified as a significant liability by the department finance manager.

In 2017, WFPS recorded approximately 20,000 patient contact that didn’t result in transport. Nicola established an automated ePCR routing process to ensure that these patient reports are reviewed by the system to ensure compliance with certain benchmarks and parameters and where it’s determined that the documentation doesn’t meet the requirements, the record is routed for further review by a supervisor.

It’s noteworthy that all these improvements have been accomplished over the last 24 months since the establishment of the Service Quality and Patient Safety Officer within the WFPS and Nicola’s appointment to that position.


In Her Own Words: Reporting System + ePCR Data Surveillance = Success

“In my experience, the most efficient way to accomplish patient centered quality improvement is to establish a reporting system that frontline providers feel safe to use. Patient Safety Event reporting, combined with conscientious investigation has proven to be a fantastic window into our system.

If you can supplement reporting information with ePCR data surveillance or data analysis, the insight into your system’s performance is even more powerful.  Once you have meaningful information about gaps in your system, applying S.M.A.R.T (specific measurable achievable relevant and time bound) criteria to improvement ideas can help you focus limited resources on initiatives with the greatest potential to be successful.”

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