1. Show providers that data matters. Patient care reports (PCRs) represent the practices of not only the EMS profession and caregiver; they’re often viewed as the measure of quality for the EMS service itself. They provide the story of the patient encounter and also give the EMS manager a window into the overall performance of their service and its caregivers. It’s therefore vital that the documentation be accurate, timely and measurable. There’s little emphasis on documentation in EMS curricula, especially from a quality improvement perspective. Therefore, it’s imperative the EMS manager provide the “real world” education on accurate and measurable documentation, as well as show examples of how the data is used to make the system better. Data gathered from PCRs is only as good as the data entered into the PCR—and the data entered will only be good if you can show providers why it matters.
2. Audit quality of data in addition to quality of care. We often think of using the information in PCRs to measure personnel performance on skills like intubation, IV access, medication administration, etc. But do you really know how accurate that data is? If you use data from run reports to track skill maintenance for individuals within the service, have you ever noticed how often the person writing the run report is also the person who did everything on the call, almost as if no one else was there? How many individuals were on the call? Did the same person really perform all the tasks? A quality assurance and improvement program must include auditing the quality of the data being entered, not just the quality of the care provided.
3. Train new hires. Orientation to the service should include a course on PCR writing, inputting accurate and pertinent data, the importance of data collection procedures and how that data will relate back to the provider. Go beyond a standard orientation about how to use the PCR software, and show new hires how the effects of good or bad data input affect reflects both the provider and the EMS agency as a whole.
4. Look beyond standard benchmarks. The “I will only enter as much in my reports as I’m required to enter mentality has to be prevented at the management level. Providers will follow management’s leadership, so if you only look at the outcomes or benchmarks required by regulators, field providers will only enter the information required to get the job done, not to get it done well.
5. Use data to provide praise. Quality assurance is often used to “weed out the bad seed;” however, sharing examples of how good care led to a good patient outcome is just as important. Providers need to be praised for good care and good documentation. They also need to be educated and encouraged when documentation or care misses the standard, in order to prevent them from viewing quality assurance and quality improvement in a negative light, which may lead to a provider omitting actions they believe they may be disciplined on or only documenting the bare minimum to meet compliance.