QA/QI Data Collection and Implementation

Friday, December 1, 2023

2:30 PM – 2:45 PM PST

Location: Town and Country Ballroom B

Primary Presenter(s)

Clark Church, NREMT-P FP-C CP-C

Director Clear Creek Health Assistance Team
Clear Creek EMS
Lakewood, CO, United States

Disclosure(s): No financial relationships to disclose

Moderator(s)

Kimberly K. Harkins, MPH

Center for Resuscitation Medicine Program Director
University of Minnesota
Minneapolis, MN, United States

Disclosure information not submitted.

Disclosure(s):

Clark Church: No financial relationships to disclose

Summary: This presentation explores implementation or improvement of an in-place QA/QI process. Data collection, interpretation and finally system implementation are all key components.

Synopsis: Participants will learn about the method developed for a full review of any cardiac arrest run in Clear Creek County, Colorado (population 9,000) as well as the ways we have implemented changes to our procedures and training modalities.

Initial data gathering includes the written PCR, the .pco file which is the continuous ECG read out provided after each call, the data from our automated CPR device, CAD/Dispatch notes, intubation videos and information provided from the crews during debrief.

Now that we have all that information how do we decipher it? We will cover a simple template we have developed to quickly move through the review process, including sections to evaluate written documentation, CPR cycles, intubation feedback, a general summary and most importantly a spot for "system-wide training suggestions."

We’ll then discuss ways that we've been able to implement these system-wide training suggestions as non-invasive and supportive. Some changes have included smoother integration of the mechanical CPR device, better time-keeping for CPR cycles, and monitor pre-charging. We have aslo created a template to explore the maximum amount of interventions we think are able to be preformed in each round of CPR without diminishing the resuscitation. We looked at everything from bag layout to where we put our equipment during the event.

The true purpose of this discussion is to share a model we have found efficient in increasing the work flow of a cardiac arrest in a system with limited resources, which ultimately leads to better outcomes for our patients.

Learning Objectives:

The top learning objectives will be about data collection and implementation.
There is more to review than just a written PCR. All cardiac monitors provide access to continuous ECG readouts which can be viewed and analyzed to give a picture of what is happening. Do we need to change the way the monitor provides information to get the most out of our device? Did we look at our CAD notes and see who was first on scene? Was it a first responder or transport unit? Did they have an AED? Every piece of information gives us more questions which we can attempt to answer.
Once we've gathered an analyzed this data what do we do with it? You may identify 100 problems but what's most important to focus on right now. Is there anything that's inhibiting high quality CPR? Were the CPR cycles too short or too long? Were the pulse checks over 10 seconds? Maybe we determined the equipment in our bags are too difficult to get to, how do we smooth out this process?
My hope is by the end of this presentation attendees will see the wealth of information available after an event like a cardiac arrest and be able to make changes to work flow. By having a strong routine, the inevitable difficulties of a dynamic event won't disrupt patient care.
This presentation will include strategies for implementing data collection and quality improvement programs in an ECC system to support accountability and reporting.