Quality Improvement in Emergency Medical Services: Key Strategies

Introduction

A fundamental principle is that the philosophies of healthcare quality are equally applicable to Emergency Medical Services (EMS). Numerous descriptions of quality in health care exist; nevertheless, the most extensively cited and most pertinent to EMS systems is the definition framed by the Institute of Medicine (IOM). The Institute of Medicine defined quality as the extent to which health services for individuals and populations increase the probability of desired health outcomes, and are consistent with current professional knowledge. In addition, the IOM identified six distinct dimensions of quality care: being efficient, providing safe care, being effective, being equitable, being timely, and being impartial.

When applied to Emergency Medical Services, the IOM's conception of quality care involves a system design that provides a particular organization of personnel, facilities, and equipment working to ensure both the genuine and corresponding delivery of health care services under emergency circumstances, as well as high-quality and appropriate care. This ideal system design is theoretical, given that the majority of EMS systems evolved as a reaction to community needs for emerging health care services rather than as an a priori planned EMS infrastructure (El Sayed, 2011).

Measuring the level of quality in Emergency Medical Services systems is difficult and complex; it must always take into consideration that EMS involves the practice of medicine in the pre-hospital and emergency environment. The objective of EMS Performance Measurements (EMSPM) is to apply knowledge, information, and experience to assess and improve the delivery of EMS services, the performance of personnel, and the standard of medical care. The necessity for improved patient care coordination and higher-quality care at lower costs has made it vital for EMS organizations to have pre-established quality control or quality improvement programs that rely on significant performance indicators to constantly monitor overall system performance and the efficacy of different pre-hospital interventions (Rahman et al., 2015).

Quality Improvement Background

From the time the National Highway Safety Act was enacted in 1966 and emergency medical services (EMS) formally commenced, the common objective of EMS systems has been to decrease preventable deaths, disability, and illness. While this objective remains constant, the sector has been increasingly challenged by the public and consumers with the demand that EMS provide the highest level of quality service at the lowest possible cost. There are strong expectations for value-added health outcomes, improved quality, and enhanced efficiency. There is a growing focus and emphasis on quality across the United States.

When considering terms such as "total quality management," "continuous quality improvement," and similar designations applied to the quality improvement movement, the shared direction is toward meeting the needs of those who pay for and use the services and products delivered by EMS organizations. All industries, including the health care sector, have reduced costs and improved the quality of their operations and products by working to meet the requirements of the individuals and consumer base they serve (United States Department of Transportation, 1997).

Effect of Ineffective Quality Improvement

A review of the literature reveals numerous reasons for implementing quality improvement programs. The advancement of EMS has created the need for a more systematic means of ensuring the delivery of quality care in the pre-hospital environment. The EMS sector has come a long way from simply transporting patients to performing the more advanced and invasive procedures prevalent at the emergency scene today. Quality assurance is too often perceived as an unwelcome condition imposed by a supervisory body on medical providers as they deliver care. In point of fact, quality assurance is to medical care what editing is to a newspaper: an opportunity to detect errors and make appropriate corrections before any harm is done (Estepp and Crabtree, 1988).

The decentralized nature of emergency medical services requires that proper quality care can be attained only if field providers have the opportunity to observe, monitor, and educate themselves, and thereby confirm their own competencies (Bingaman, 1994). It is important to note that not just EMS but all agencies strive to attain success and excellence when their personnel feel genuinely invested in the work they perform (Libby and Valradian, 1994). One of the major factors that helps emergency medical services personnel feel invested in their work is peer-driven quality improvement (PDQI). Peer-driven quality improvement in the pre-hospital care setting means that the individuals responsible for improving the quality of care provided in the field are the same individuals who deliver that care (Bingaman, 1994). If EMS agencies and organizations fail to account for the peer-driven aspect of quality improvement, they reduce the patient care experience to a potentially mechanical application of protocol that does not encompass truly quality patient care (Bingaman, 1994).

The effect of an ineffective or nonexistent quality improvement program can be seen in several areas, including but not limited to consumer complaints, recurring errors, and poor patient outcomes. Although the challenges of health delivery systems and emergency medical services are somewhat distinctive, the principles of quality management hold significant potential for transforming the pursuit of quality improvement in health care (Ryan, 1994).

Conclusion

Now more than ever, there is increasing urgency from the general public demanding that Emergency Medical Services provide the highest quality service at the lowest possible cost. There are very clear expectations for improved health, improved efficiency, and overall improved quality (USDT, 1997). It is imperative for an EMS agency or organization to have programs and agendas in place that analyze, evaluate, and assess the manner in which the organization and its employees are operating. Given the effectiveness of quality management programs in the manufacturing industry, it was inevitable that other sectors — including Emergency Medical Services — would adopt these programs for their own needs (Spivak, 2000). The capacity of EMS to meet the needs of communities and individual patients in an optimal manner in the years ahead is dependent on appraisal processes that evaluate, enhance, and improve the quality of Emergency Medical Services. Continuous and relentless assessment is vital and should encompass all aspects of every EMS system.

Several imperatives facilitate the emphasis on improving operational processes that affect overall quality improvement in emergency medical services. Leadership is one such imperative; the key role of the EMS leader encompasses supporting and promoting quality improvement within the agency or organization. Achieving advanced levels of performance requires that EMS leaders develop a strategic quality plan that integrates quality improvement into their organizational system, ensuring that all practices and procedures concentrate on the needs of patients and other stakeholders. Another imperative is the satisfaction of patients and other stakeholders. The primary objective of EMS systems is to satisfy patients and stakeholders alike. An EMS system aiming to improve quality must have communication processes in place to receive, evaluate, and respond to compliments, criticisms, and comments in all the various ways they may be expressed. Finally, information and analysis constitute a critical imperative. Data collection and analysis are essential to the effective design and execution of a strategic quality plan. EMS systems should pursue those data and information activities that their current resources permit, while simultaneously working to build their capabilities through data collection, management, and benchmark comparisons (USDT, 1997).

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