The effect of a quality improvement feedback loop on paramedic skills, charting, and behavior.

OBJECTIVE

A mechanism was initiated for conveying quality improvement (QI) results to paramedics as a means of improving chart documentation in difficult-to-correct areas. This study examines the impact of this QI feedback loop on charting, resuscitation rates from cardiac arrest, endotracheal intubation (ETI) success rates, and trauma scene times.

DESIGN

Paramedic trip sheets were reviewed before and after the institution of the QI feedback loop in this interrupted time series design.

SETTING

The New Castle County, Delaware, Paramedic Program.

PARTICIPANTS

All New Castle County paramedics participated in the study.

INTERVENTIONS

In January 1990, the medical director began to circulate a QI summary among the paramedics in an effort to improve performance and chart documentation. The summary focused on the management of respiratory distress or arrest, cardiac arrest, and major trauma. The success rate for ETI was compared with the rate of field resuscitation from cardiac arrest, the percentage of unjustified prolonged trauma scene times (longer than 10 minutes), and the percent compliance with minimum endotracheal intubation documentation (ETID) requirements from a six-month period before institution of the QI feedback mechanism with data obtained from a six-month period after the program had been operational for one year.

RESULTS

Comparing results from before with after the initiation of the QI program, the ETI success rate was 273 of 295 (92.5%) before and 300 of 340 (88.2%) after (chi 2 = 3.04, p < .1, ns); field resuscitations totaled 26 of 187 (13.9%) before and 44 of 237 (18.6) after (chi 2 = 1.40, p < .25, ns); ETID rate was 249 of 295 (84.4%) before and 336 of 340 (98.8%) after (chi 2 = 44.24, p < .001), and unjustified prolonged trauma scene times were 69 of 278 (24.8%) before and seven of 501 (1.4%) after (chi 2 = 320.5, p < .001).

CONCLUSION

The use of QI feedback had little effect on psychomotor skills as the ETI success rate or resuscitation rate, but had a dramatic effect on chart documentation, as evidenced by ETID rate, and behavior, as evidenced by the reduction in prolonged trauma scene times. The use of QI feedback is recommended as a means of correcting charting deficiencies or modifying behavior.