Improving EMS Report Quality

The QA reviewer has the power to gradually increase or decrease the quality of run reports submitted by crews company-wide.

QA Fails Lead to Higher Report Quality

The only way to bring up report quality is to fail the bad ones, period.

When you fail a report back, take the time to explain your objections; don't rely on the built-in summary text. Every objection can be a teaching moment, provided that your word choice does not put the crew member on the defensive.

When the report comes back corrected, don't let anything slide: re-check every objection, don't pass it until you feel confident that the report could be read aloud in a malpractice lawsuit.

Supervisor followup is required

Make sure your crews understand that their QA fail rates are monitored.

Crew members can see their own rates when they view their Employee Self-Edit page. Supervisors, meanwhile, can view these reports:

• Crew QA Performance Report shows all crew members' QA performance numbers.
• Crew QA Performance Visualizer shows all crew members' QA pass and fail rates, and time to clear QA, plotted over time. This shows who is improving and who is not.

Supervisors should meet with the lowest-performing employees every month, review the reports together, and set expectations for improvement over the coming month.

An Occasional Bite to Reinforce Your Bark

If you are putting in the effort to explain each objection, and attempting to turn every error into a positive teaching moment, yet the crew member isn't showing a good attitude, escalate the matter as an incident.

The incident system is always open to all employees. As a QA reviewer, you have the power and responsibility to use the system to raise your concerns to management... and by using the incident system to do so, you create a permanet record that may be useful later.

Pressure from Management

If you increase your QA failure rate, it may increase the days-to-bill, because run reports are taking longer to graduate from QA to the billing office. Management may notice the delay, worry about a drop in cashflow, and demand an explanation.

Or you may already be under pressure to pass reports more quickly, in order to speed up the revenue pipeline. This would require you to further lower your standards.

To make your case for higher standards, you must persuade management that the slowdown of the revenue pipeline will be a) temporary, and b) worthwhile.

It's temporary.

The slowdown of the revenue pipeline will be temporary because every EMT and paramedic can be trained to write a good report. It does not require special talent, it just requires training (or a mentor) and discipline (from within or without).

Mentoring is an excellent way to quickly increase the quality of run reports. You probably have some crew members who write good reports, who can be counted on to teach others. When you fail a report back to a crew member who is struggling, notify the relevant supervisor (or submit an incident record) that a mentor is needed. You can also use the "QA Reviewer Comments" box to direct the crew member to seek out a specific mentor. If the supervisor can then arrange to put the trainee and the mentor on shift together, then the mentorship will happen in the field, requiring no additional time on the clock.

If unsatisfied with the pace of improvement, consider adding a negative motivation: ask the crew member's supervisor to set a deadline, and if the deadline is missed, the crew member will be demoted to wheelchair van duty, or suspended, or switched to part time, or whatever incentive seems to be effective.

Anyone can learn how to do it right. In the experience of AngelTrack LLC's own counselors, it takes 2-4 weeks to bring all crews at a company up to standards. The exact timeframe depends on how many good mentors you have to start with, and the strength of the public support from management.

It's worthwhile.

Low-quality reports can hurt the company in five ways:

1. When an ADR ("Additional Documentation Request") arrives from Medicare, you must send in all run reports for the specified patient(s) and date(s). If Medicare decides your reports are insufficient, they will deny your insurance claims.
2. In response to a complaint from a patient, or a patient's family, or a nursing home, or a hospital, or an ex-employee, inspectors from the state or from cities can visit your headquarters and inspect your run reports. Depending on what they find, and on local and state regulations, your company could be fined, publicly sanctioned, refused a license renewal, or even shut down.
3. When a patient is serviced regularly, the details in the run reports can help your crews spot health problems as they develop. These details -- little observations, comments, and patient statements -- must be entered by the attending; the narrative auto-composer cannot do it alone.
4. If there is a lawsuit for malpractice, negligence, or wrongful death, all of the patient's records will be subpoenad... even if you aren't the company being sued. For example, if a patient dies due to a mistake at an ER, the ER will immediately blame EMS, and then your patient records will be demanded. They may be read aloud in open court. The lawsuit might even pivot on a single sentence in the run report. And of course the media could get hold of it.
5. Employees want to be proud of where they work. They enjoy the knowledge that they are part of a crack operation that insists on high standards. They want to know that their patients are lucky to be served by their company, rather than by a sloppy competitor. So, although there will be grumbling in the short term, high standards raise morale in the long run.