Care Ambulance Clinical Department

The Clinical Coordinator was established for a number of reasons, not the least of which was to bring the standard of care provided by Care Ambulance to a level that is higher than anywhere else.

The Clinical Coordinator is responsible for establishing, monitoring, enforcing and tracking the Quality Improvement, as well as compiling a database of usable information that will allow for further enhancement of the service provided by Care Ambulance.

The Clinical Coordinator shall also assist the Billing Office with a review of Billable Event Documents created, and submitted by field providers, with special emphasis on accuracy of medical necessity.

Auditing Process

The Clinical Coordinator of Care Ambulance is responsible for ensuring that a clinical audit of no less than one hundred percent of designated ambulance transport records is conducted.

Clinical Documentation is sorted by level of care (BLS, ALS, CCT) and collected for Quality Improvement review.  Each report shall be reviewed and signed, with exceptions of pulled for rapid triage and follow up by the Clinical Coordinator.

Each clinical report shall be reviewed with particular attention to the following:

·        Consistency and continuity of care

·        Standard of care based on protocol and accepted practice

·        Appropriateness of care based on protocol and patient condition

·        Appropriateness of receiving facility based on original request, patient condition, and medical control

·        Medical control consultation based on protocol and patient condition

·        Violations of established Local and State Protocols

·        Variations of established Local and State Protocols

Record Keeping and Performance Tracking

After the auditing process, all non-exceptional clinical patient care report documents shall be maintained in accordance with Local and State standards and guidelines.  Run reports are logged and filed.  At the end of each month, run reports, along with the Monthly Date Report shall be forwarded to the appropriate state authorities as required.

Run reports which are flagged and pulled shall be investigated and maintained in separate files that includes all of the supplemental documentation and information, in accordance with State and Local standards and guidelines.

The Clinical Coordinator shall maintain a comprehensive database used to track and monitor a variety of performance levels.  Ultimately, the database will be used to isolate and understand specific clinical information based on procedure, provider, illness, or any combination thereof.  Moreover, this information can be used for specific training and incident trending.

Incident Investigation

When a report involving a potential or obvious exception is identified by the Quality Improvement Process, it shall be expeditiously separated and investigated.  All investigations involving a violation, variation, or deviation in the standard of care shall be fully investigated within five days of occurrence.

The investigation process involves:

·        Immediate notification of the Clinical Coordinator

·        Interviews with all of the caregivers and witnesses involved

·        Written statements from all Care Ambulance employees who are involved

·        Complete review of all clinical, legal and ancillary facts

·        Complete review of all associated documentation, such as patient care reports, billing tickets, dispatch logs, etc.

The investigation shall be conducted by the Clinical Coordinator and a summary of the investigation shall be written and forwarded to the General Manager and Medical Director.

Violation and Variance Reporting

When a violation of, or a variance on, any Local or State Protocol, or deviation in the standard of care, is identified and confirmed, the appropriate regulator agency is notified.  In accordance with State and Local guidelines and official Occurrence Report Form is completed and sent to the appropriate State agencies within five days or awareness of the occurrence.

Full written documentation, including; Patient Care Report, Incident Reports, and documents of remedial action shall be submitted to the state EMS Medical Director’s Office within thirty-five days of the incident.

By policy and statute, the Clinical Coordinator as well as all Care Ambulance staff members are required to comply with all appropriate regulatory procedures with respects to incident reporting.

Counseling, Remediation and Corrective Action

One of the keys to the success of the Quality Improvement process is the built in accountability. Because each instance is investigated, documented, and reported, corrective action taken at the time of the occurrence (if necessary) is more appropriate and consistent with remedial/ corrective action steps.

The Clinical Coordinator, in association with the Director of Operations (when appropriate), is responsible for the management of all exceptional cases.  The process used to counsel, direct remediation, or issue corrective action may involve any of the following:

·        Comprehensive case reviews with the Medical Director

o       The Medical Director may direct or actively participate in the full case reviews

o       After such review, the Medical Director and Clinical Coordinator shall confer and decide on an appropriate course of action.

·        Activation of the Medical Review Committee

o       This internal process is used for somewhat less severe cases and functions much in the same manner as the Medical Director review

o       The committee consists of:  Medical Director, Clinical Coordinator (Chair), one member representing each provider level, one member of the management team

·        Remediation and/or additional training

o       The Clinical Coordinator, in conjunction with the Medical Director, may request or direct that additional training be conducted on the core issues at hand with the provider or providers involved

o       This training or remediation may become a condition of continued affiliation and/or employment with Care Ambulance

·        Corrective Counseling/Disciplinary Action

o       Generally conducted with an Operations Supervisor (or Director of Operations when appropriate)

o       All disciplinary measures instituted for violation/deviation in the standard of care shall be in accordance with accepted Care Ambulance disciplinary procedures.

Routine Case Reviews

Six cases shall be randomly selected each month to be evaluated in the form of a case review as follows:

·        Two BLS

·        Two ALS

·        Two CCT

Each case shall be presented to the Clinical Coordinator in writing, using the following outline, and shall include the following information:

CASE HISTORY

Run Number

Level of Care

Provider’s names and level of certification

Origin and Destination

Patient Condition at time when care was assumed by Care Ambulance providers (include circumstances and nature of transport, patient history, vital signs)

Care provided by Care Ambulance

Patient Disposition

Summary

The Quality Improvement program forms the cornerstone of improved patient outcomes.  It is through the quality improvement process that enhanced patient care standards may be identified and implemented.

The Quality Improvement program at Care Ambulance is designed to allow for constant growth and development, thus constant change.  It is this commitment to change that allows the Quality Improvement plan, and ultimately the organization to be successful.

The Quality Improvement program fulfills the requirements for quality assurance in an EMS Operational Program as governed by Local State guidelines.