QA QI Process Maryland Institute for Emergency Medical Services

QA/QI Process Maryland Institute for Emergency Medical Services Systems

Overview n Presentation developed to provide understanding of: n n Actual Case Studies n n n QA Process Maryland Regulations that affect QA & EMS Providers How Regulations affect day to day EMS operations demonstrate impact of Regulations EMS in Maryland. EMS Board has issued Noncompliance Notices &/or Final Decisions for all Cases reviewed Noncompliance Notices &r Final Decisions are Public Documents

Overview QA Process n n Trigger - Identify Issue 5 Day Report QA Officer Investigation Medical Review Committee n n Remediation 35 Day Report Request MIEMSS Action or n Request Case Closure n

n n n PCQA IN-5 5 -days of notice Suspend Privileges? Contact State EMS Medical Director

n n PCQA IN 35 Suspend Privileges? Contact State EMS Medical Director

Privileges Limited!

Overview QA Process n MIEMSS IRC n n n Investigator, AG and EMS Medical Director Summary Suspension Provider Review Panel n n FR EMT-B EMT-I EMT-P n n n EMS Medical Director Med Chi MD Board of Physicians

PRP Recommendation/Action n n n Dismiss Complaint (if patient care related) Deny Application Reprimand Remediation Probation Suspension Revocation

EMS Board Process n n n Dismiss Complaint Additional Investigation Proposes Discipline Issues Noncompliance Notice Applicant/Provider Accepts Proposal n Requests Hearing n

EMS Board Process n Applicant/Provider Accepts Proposal EMS Board Issues Final Action/Public Order n Reports Discipline n Healthcare Integrity & Protection Data Bank (HIPDB) n NREMT n EMSOP Medical Directors n

EMS Board Process n Applicant/Provider requests hearing MIEMSS notifies OAH n OAH Schedules Hearing n n MIEMSS Schedules Case Resolution Conference

Case Resolution Conference (CRC) n CRC accepts resolution n n Results presented EMS Board accepts CRC resolution OAH Hearing canceled n EMS Board Final Action n Reports Discipline n

Case Resolution Conference (CRC) n n n CRC panel rejects resolution IRC Complaint to OAH Hearing Administrative Law Judge (ALJ) issues decision 90 days n n Decision non-binding on EMS Board considers Administrative Law Judge (ALJ) findings n Issues final action

EMS Board Process n n EMS Board issues Final Action/Public Order Report to Healthcare Integrity and Protection Data Bank (HIPDB) Provider must exhaust administrative remedies Applicant/Provider may appeal EMS Board decision to the Circuit Court

EMS Board Process n n EMS Provider may not surrender certificate or license during an investigation of IRC Complaint unless EMS Board wishes to accept it EMS Board may not allow certification or license to lapse during disciplinary process

Noteworthy Cases

Typical Case Closure n n n Administration of Epinephrine instead of Lasix IV Esophageal Intubation Important to get even minor complaints so can look for trends and make system changes n EMT-B giving ALS provider NTG

Atypical Case Closure n n Case closure requested by EMS Jurisdiction MIEMSS documented other Incident Reports Consolidated cases Issues IRC Complaint

Criminal Conviction n n Self-reported criminal conviction Discovered criminal history Not reported to MIEMSS n Prohibited Conduct because of lying on application n n Discovery/Report EMS Provider convicted new crime

Criminal Conviction n n Child Sex Offender Why it is so important to identify and report criminal convictions

EMS Provider Credentials n Jurisdictional Medical Director Limits credentials n Clinical competence n Medical decision making

n n n PCQA IN-5 5 -days of notice Suspend Privileges? Contact State EMS Medical Director

EMS Provider Suspended n Local n n Summary Suspension n n During investigation (State considers public threat) Threat to Health and Welfare of the public (call State EMS Medical Director) Opportunity for Immediate hearing CASE review Parallel Regular Investigation NREMT notification

Questions n Provider “due process” n Protects public and provider

Case Review ? ? ? ?

EMS Board Actions FY 2006 & 2007

Compliance Office n FY 2006 ACTIVITY REPORT OF THE INCIDENT REVIEW COMMITTEE (IRC), EMS PROVIDER REVIEW PANEL (PRP), AND THE EMS BOARD n Incidents Reported to IRC 312 n IRC Investigations Initiated 235 n IRC Investigations Conducted 207 n IRC Investigations Continued FY 2007 28 n IRC Complaints Forwarded to PRP 30 n Complaints Dismissed by PRP 0 n Complaints Forwarded to EMS Board 30

Compliance Office n n n FY 2006 EMS Board Action • Reprimands • Probation • Suspensions • Revocations • Remedial training • Surrenders • Evaluation • Applications Denied • Case Resolution Conferences • Dismissed • Counseling 8 12 5 6 3 1 1 9 7 0 1

Compliance Office n FY 2007 ACTIVITY REPORT OF THE INCIDENT REVIEW COMMITTEE (IRC), EMS PROVIDER REVIEW PANEL (PRP), AND THE EMS BOARD n Incidents Reported to IRC 295 n IRC Investigations Initiated 215 n IRC Investigations Conducted 200 n IRC Investigations Continued FY 2007 15 n IRC Complaints Forwarded to PRP 32 n Complaints Dismissed by PRP 1 n Complaints Forwarded to EMS Board 31

Compliance Office n n n FY 2007 EMS Board Action • Reprimands • Probation • Suspensions • Revocations • Remedial training • Surrenders • Evaluation • Applications Denied • Case Resolution Conferences • Dismissed • Counseling 3 4 3 7 3 0 1 3 7 1 1

More Information n MIEMSS’ contact Richard Alcorta, MD n Sarah Sette, AAG n Ron Schaefer, CCO n (410) 706 -2339

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