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Recognize the importance of PI to trauma care in general
Review generic PI program design for trauma centers and prehospital providers
Understand how to deal with common quality problems
Appreciate nuances in PI for EMS and at Level III centers
www.TheTraumaPro.com/rimrock
4
What Is PI?
“This event is less likely to occur again because…”
5
What Is PI?
“This event is less likely to occur again because…”
Importance of PI Program
Important to verifying agencies – EMS Board – Department of Health – American College of Surgeons
Important to you – Documents the quality of the trauma care that you provide – Monitors the care before transfer out at Level III centers – Monitors care during prehospital transport
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Performance Improvement Program
What it is – Continuous monitoring of processes and outcomes – Time and data intensive – Vitally important to the existence of your agency
What it is not – Easy – Cheap – A guarantee of passing your site visit
Reviewing trauma activation and consultation criteria with new ED physicians Educating nonsurgical service chiefs
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“Closing The Loop” - EMS
Needle thoracostomy found not to be in the pleural space Peer problem – Counsel provider – Educate the group – Personnel file
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“Closing The Loop” - EMS
Needle thoracostomy found not to be in the pleural space System problem! – Needles too short – New brand/type – No more problem!
“Closing The Loop”
Monitoring – Repeat data collection
Monitor all needle thoracostomies until enough performed to judge effectiveness
Documentation – Maintain an easily followed audit trail of entire process
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Specific Pointers
PI personnel & staffing needs to make sense for your program!
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Specific Pointers
Work closely with your PI personnel – Don’t abandon/hate them!
Make sure all possible routes into the hospital are covered – How to deal with admits to nonsurgical services – Direct admits
Specific Pointers
Attend to all PI in a timely manner
Maintained detailed documentation of all discussions, in writing – Direct – Minutes – Email?
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Specific Pointers
Organize, organize, organize – Use your registry or other software
Patient folders System issue folders Open item list
– Keep a list of your successes
Specific Pointers - Hospital
Mind your registrars – 1 FTE per 500-750 trauma registry admits – Don’t underestimate TQIP
Don’t forget trauma activation patients who are discharged from the ED!
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Specific Pointers - Hospital
Organize your PI well for your site visit – – – – –
Patient folders System issue folders Flag key areas of your medical records Assign one EMR expert to each reviewer Test everything that is not made of paper
Final Pointers
Design a solid PI program foundation
Take the initiative to make the process meaningful
Pay as much attention to PI as you do to your clinical responsibilities
Find creative solutions to tough problems and document them well
Document everything, and document it in an easy to follow format.
