Ambulance call reports generated from paramedics and received at the RPPEO are reviewed by their peers. Calls where an advanced care and/or primary care paramedics were involved are reviewed by a certified advanced care paramedics however primary care paramedics do not review calls where an advanced care paramedic crew attended. Peer reviewers are selected, by the RPPEO quality management team, from various EMS services, in our catchment area. Each reviewer is provided direction on call review. Once the call is reviewed, and does not meet the ALS PCS standards, a Paramedic Call Review (PCR) form is generated. (PCR form link) This PCR form is then reviewed by the lead reviewer and if they are in agreement with the peer reviewer a request for response letter is generated and sent to the paramedic, their Clinical Performance Coordinator (CPC) and a member designated by their service. Feedback is provided to the call reviewer when a discrepancy is noted. A response is required within a designated time frame. The purpose of the response is to clarify or justify the actions taken on the call. A response may also be necessary if clarification is required in regards to the documentation presented on the ACR. If no response is obtained within the specified time frame, an email is sent to the service requesting that they advise the RPPEO if there is an unforeseen event such as, but limited to, a leave of absence, sick time or vacation period. The due date may be extended at the discretion of the RPPEO. There is risk of deactivation if there is no unforeseen event and the paramedic has not responded. Once the response is received and reviewed, several options are available: A final grading is provided to the paramedic and the call is closed – no further action required Further information is required from the paramedic The associate medical director for quality reviews the call which can lead to: A final grading is assigned and sent to the paramedic, CPC and service representative. A Clinical Review Committee meeting being scheduled A meeting between the paramedic and the associate medical director for quality
When a paramedic self reports a variance committed during a call, the call is reviewed and then placed through the call review process. Once this review is completed, feedback is provided to the paramedic who self reported. (Self-reporting link)
Upon the request of the service or the associate medical director a meeting is held to discuss, medical consultation and recommendation(s) for case specific issues related to pre-hospital clinical patient care. This committee also: Identifies and facilitates learning opportunities and to meet the learning needs of paramedics certified by the RPPEO. Provides medical advice, and make recommendations for medically appropriate clinical care. Identifies the need for, and provide direction for remediation related to clinical care, for specific paramedics.
Clinical excellence letters process Peer review is performed on calls with a delegated medical act. If the reviewer deems that the care provided was both timely and appropriate and the documentation was clear and thorough, the call is then reviewed by the associate medical director of quality. Once approved, a clinical excellence letter is generated and sent to the paramedics and a copy is also sent to the respective service. RPPEO Survivor pin recipients’ process All calls where a patient has vital signs absent will be entered into the system and reviewed for patient outcome. This may take several weeks as a patient is deemed a survivor when they are discharged alive from the hospital. Paramedic students as well as CACC communications officers, involved in the call, will receive a survivor pin and letter from the medical directors. Complaints All documents are obtained where a written complaint is submitted to the RPPEO. It is then reviewed by the associate medical director for quality. Once reviewed feedback is provided to the complainant. If a complaint is comportment or operational related, the service is advised.