The Ambulance Call Report continues to be among the paramedics' core responsibilities in patient care. As such an important element of the patient's chart, the RPPEO's quality management team is continually examining the ACRs that paramedics in Eastern Ontario prepare. We do this as one way to measure the quality of care for patients. All of our quality measurement helps the RPPEO improve care quality for patients and build better education tools for paramedics.
In the great majority of cases, paramedics do indeed apply the current patient care standards.
The Ottawa Hospital formally adopted Just Culture as an underpinning concept to the improvement of patient care quality. As we work toward a Just Culture, the RPPEO acknowledges that the terminology used in Just Culture may be at odds with the language used in some certification, education or quality documents. However, our intent is always to improve future patient care through a collaborative learning experience.
The RPPEO regularly reviews our own processes using continuous quality improvement methods. We work toward making peer review, ACR reviews and all the other quality management processes fairer, more transparent and better tools for patient safety and quality. You can learn more about the RPPEO Quality Program policies by clicking here.
Read on to find out more about how the RPPEO currently reviews ACRs.
Ambulance Call Report Review Basics
The RPPEO reviews care provided by certified paramedics, including that documented in the ACRs, according to the most recent Patient Care Standards. The authoritative documents describing standards of care are available here.
The RPPEO examines ALS care that does not appear to follow current standards or has some type of clinically relevant variance. During ACR review, the RPPEO sends our questions or concerns with ALS care to the paramedic, their Clinical Performance Coordinator (CPC) and a member designated by their service. The tool we use for this is the Paramedic Call Review form.
Paramedic peers are the eyes of ACR review at the RPPEO. They are constantly poring over ACRs to see if their peers have applied the current standards of care. And, in the great majority cases, peer reviewers find the evidence that paramedics do indeed apply the current patient care standards.
When a peer reviewer can't be certain that the standards have been well applied, the reviewer flags that ACR for further review. The RPPEO lets the ambulance services know about any potential issues in Basic Life Support (BLS) care standards. The escalation of potential Advanced Life Support (ALS issues) takes the ACR to the RPPEO's quality coordinators, whose job it is to make sure that any potential issues noted with paramedic ALS care are resolved.
Paramedic Call Review
During the ACR Review process, questions can arise that only the paramedics who provided patient care can answer. The RPPEO uses a standard procedure called Paramedic Call Review to ask these questions.
The Paramedic Call Review (PCR) form is a standardized way for the RPPEO to follow up on potential ALS issues identified in quality management processes like Ambulance Call Report review. While most ACR reviews are closed without the need to follow up with the paramedics who provided care, the RPPEO does occassionally require more information. As a paramedic, you may receive a request to complete a PCR form for one or more of these reasons
- to clarify what you did or didn't do during an intervention
- to justify your actions or inactions during care
- to clarify documentation such as the ACR, biometrics, patch recordings or others
The RPPEO provides a response period to paramedics who receive a request to complete a PCR form. In the case that the paramedic does not respond before the deadline, the RPPEO will then contact the paramedic's ambulance service. The RPPEO may occassionally extend the response period in the case of extenuating circumstances such as a paramedic's leave of absence, extended illness or vacation period. It is, however, important that the paramedic who receives a request for information from the RPPEO responds by the deadline: the RPPEO may deactivate a paramedic's certification if we do not receive a response within the allotted time. See the footer at the bottom of the page for information on how to contact the RPPEO.
Outcomes following Paramedic Call Review
Once the RPPEO receives and examines responses to PCR requests, the RPPEO may
- close the ACR review. In this case, the RPPEO and its quality management team determine that care met the standards.
- request further information. The RPPEO once again requires more details to make further decisions.
- escalate the ACR review to the associate medical director for quality, who may in turn close the ACR review, request further information in writing, call an in-person meeting with the paramedic, or call a Clinical Review Committee meeting to review the case.
In any of these cases, the paramedics who provided care in the ACR under review may receive a letter outlining the details found during the review and recommendations or requirements for follow-up.
Triggers for the Ambulance Call Report Review Process
It's impractical and unnecessary to review every ACR for every aspect of care. Instead, the RPPEO quality management team conducts ongoing sampling of ACRs for review. The methods we use for sampling vary depending on the reason for the audit. For example, following certification with the RPPEO, new paramedics are subject to a 100% review of their ACRs. The RPPEO does other ACR audits for ongoing quality assurance, targeted review of care like medication administration, or validation of quality improvement strategies. The Ministry of Health and Long-Term Care also provides guidelines for sampling and the ratio of ACR audits required. ACR audits are one entry-point into the ACR Review process.
Sometimes, paramedics note errors or problems that they suspect may have affected the standard of care. The Self Report form is the method that paramedics themselves can use for flagging potential issues that may negatively affect the standard of care that a paramedic provides while providing care. Managers may also use self reporting to raise concerns or issues. Self reporting is another entry point into the ACR Review process.
When the RPPEO receives a written complaint, the nature of the complaint helps us determine our course of action. Complaints that appear to indicate clinical care issues will see the quality management team begin an ACR review, whereas the RPPEO asks the ambulance services to respond to complaints related to comportment or operational issues.
The Ambulance Call Report Review process is one of the many processes the RPPEO uses to monitor and improve the quality of paramedic care in Eastern Ontario. If you have questions about this process, you may contact the Quality Team.