What is a PSO?
PSOs are federally-based organizations that provide protection for your safety and quality of work. They can be used for both data collection and peer review-type protections. Created by the Patient Safety and Quality Improvement Act of 2005,1 and regulated by the Patient Safety Rule,2 PSOs provide for the improvement of patient safety and reduction of the incidence of events that adversely affect patient safety. The act established a system of patient safety organizations and a national patient safety database, with the goal of encouraging reporting and broad discussion of adverse events, near misses and dangerous conditions. It also established privilege and confidentiality protections for the Patient Safety Work Product (as defined in the act).The role of a PSO as an MIHPCP compliance adjunct
So, how can a patient safety organization that monitors adverse events, near misses and dangerous conditions help establish compliance standards for MIHP-CP programs? Because, as with any other type of medical practice area, adverse events, near misses and dangerous conditions can (and eventually will) occur in MIHP-CP practice. For example, despite the best efforts of the MIHP-CP team, an enrolled patient is readmitted to the hospital for CHF within 30 days of discharge. Or, a patient who, in accordance with established protocols, appeared stable enough to be seen at a medical clinic upon EMS field assessment, collapses in the taxi on the way to that clinic. Or, a patient receiving athome wound care develops an infection despite proper wound care techniques during routine MIHP-CP visits by the community paramedic or APRN. All of these are considered adverse events, and need to be thoroughly looked at and evaluated to minimize future similar occurrences.
Although it goes without saying that you will do your own internal review and evaluation of each of these incidents, there is no confidentiality protection for having a truly open and honest discussion that leads to quality improvement as opposed to sanctions, nor is there any legal protection from evidence discovery by a lawyer acting for the patient and/or family.
This is where PSOs can be especially helpful. Specifically, PSOs provide protection for:
- Call review documentation (for example: communication/feedback to your staff about their performance; focused reviews of high risk or other specific concerns)
- Documentation and conversations related to investigations of incident reports
- Internal studies on medication and other types of errors
- Case reviews by your agency’s medical director
- Regional quality committee meetings (certain conditions must be present)
- Most any electronic or paper documentation, notes and data related to your agency’s safety and quality improvement processes
The ability to have completely open and candid review and discussions among practitioners across agency and organizational lines in order to properly assess and evaluate the efficacy of your MIHP-CP program from all angles is critical to both the success and sustainability of MIHP-CP initiatives and the establishment of compliance standards and benchmarks. This is especially true with a new field of practice such as MIHP-CP, which is still in the early stages of development as a practice area, and whose course is still being charted.
The fact is, despite our best efforts, things happen that can cause harm. When they do, the last thing you want is to have also caused harm to the reputation of your agency and MIHP-CP program. Without legally sound confidentiality protections in place, efforts to openly review and discuss adverse events, near misses and dangerous conditions run the risk of being discoverable in court. And all it will take is one lawsuit or instance of negative press to cause a loss of confidence in your community partners, payers and participants, and bring about the collapse of an otherwise stellar and very necessary program.
By submitting information and data to a PSO for monitoring, trends can be established across multiple programs providing similar services and, if necessary, alerts can be sent out to all participants to watch out for particular triggers or situations that increase the risk of adverse events, near misses and dangerous conditions, so that they can be avoided or mitigated. Ultimately, it is this collection of information which will lead not only to best practices in the field of MIHP-CP, but also to risk management and compliance standards for this new practice area.
Finally, keep in mind that many hospitals–especially those that are unfamiliar with what EMS agencies and providers actually do–may assume that EMS practitioners are covered by peer review statutes (which, in most states, they are not), simply because their own medical staff are. Be prepared to address this upfront and make sure that the hospital executives you are negotiating with are not making false assumptions. The hospital may have certain requirements for participation in peer review and/or PSO affiliation and may require PSO affiliation as part of MIHP-CP contracting. After all, if the hospital itself is required to participate in one, it will most likely require all of its associated entities and partners to also participate in order to facilitate the open exchange of information for quality improvement and compliance purposes.
For more information about PSOs, visit the Agency for Healthcare Research and Quality (AHRQ) at www.pso.ahrq.gov and/or the Center for Patient Safety at www.centerforpatientsafety.org.4
This article scratches only the surface. Be sure to consult with your attorney, a compliance specialist or a PSO to review your organization’s specific needs and obtain appropriate advice on these and related issues.
REFERENCES
1. 42 U.S.C. 299b-21 through 299b-26.
2. 42 CFR Part 3.
3. Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 et seq. (2010).
4. The Center for Patient Safety is currently the only authorized EMS PSO in the United States.
