Improving EMS and Fire Report Quality in AngelTrack

Some suggestions for how a QA Reviewer can improve the quality of reports submitted by crews, using AngelTrack's QA review system

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

If you want to increase the quality of reports you receive from crews, a straightforward way to do so is: Start failing the bad ones, and keep failing them until they clear the bar.

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

It's up to your company policy and your own discretion to determine how detailed crews' reports need to be.

Supervisor Followup / QA Performance Reports

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

Crew members can see their own QA rates when they view the "Statistics" tab of 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.

Meanwhile, AngelTrack's Report Builder can produce analytics for time-to-reach-billing.

Using the Dispatches-Workflow dataset in the Dispatches category, you can sort your call volume by attending crew member, by service provided, and by month, and then analyze the various workflow columns including:

  • Hours From Closure To Report Complete
  • Days From Report Complete To QA Passed
  • Awaiting Corrections Count

Meanwhile the Dispatches-QAReview dataset has other useful columns, including:

  • QA Review Objection Count

Report Builder can combine multiple datasets, so you can join together all the ones you need into a single report and then add charts, sums, and averages.

You may consider having supervisors 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 are attempting to turn every error into a positive teaching moment, but are getting rebuffed, it may be beneficial to escalate the matter to management, using AngelTrack's incident system.

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

Pressure from Management

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

It's temporary

The slowdown of the revenue pipeline will be temporary because every EMT, every paramedic, and every firefighter can be trained to write a good report. The goal is within reach of every soul. It does not require special talent, it just requires training, or a mentor, and discipline, from within or from 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.

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 you get 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, or worse.
  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 city, the county, or the state can visit your headquarters and inspect your run reports. Depending on what they find, and depending on local and state regulations, your company could be fined, publicly sanctioned, refused a license renewal, or even shut down (!). It actually happens. It can happen to you.
  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 subpoenaed 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. A lawsuit could pivot on a single sentence in the run report.
  5. Employees want to be proud of where they work. They enjoy the knowledge that they are part of a quality operation that insists on high standards. They want to know that their patients are lucky to be served by their company. So, although there will be grumbling in the short term, in our experience, high standards raise morale in the long run.