Quality Assurance

Greg Scott

Greg Scott

Blast From The Past
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Decades ago—even before a formal ED-Q certification course existed at the International Academies of Emergency Dispatch® (IAED)—Dr. Jeff Clawson developed three main  goals of emergency dispatch quality assurance. The third, and most involved of those goals, was to improve compliance using regular case review feedback and continuing education.

In 1990, after evaluating some of the earliest compliance data ever collected from Medical Priority Dispatch System (MPDS®) case reviews done at the Los Angeles City (California, USA) Fire Department, Dr. Clawson was able to demonstrate a clear and fundamental relationship between “interrogation compliance”—interrogation being Case Entry and Key Questions—and Determinant Code selection accuracy. In fact, this relationship was so strong that the difference in correct Determinant Coding achieved between the most compliant interrogation cases and the least compliant ones was 56.7% (93.2% vs. 36.5%, respectively)! And given that there were only four Priority Determinant Levels in the MPDS at the time, the least compliant cases represent a degree of coding accuracy that is not much better than outright guessing (since a random guess would be right about 25% of the time).

There are two equally plausible explanations for this relationship. The first is that non-compliant cases are simply universally non-compliant (i.e., “compliers comply, and non-compliers don’t comply”). Yet this relationship likely goes even deeper than this. A second explanation is what happens when a generally compliant emergency dispatcher misses something in the interrogation process (Case Entry and Key Questions) that they would normally get right. It’s easy to see that this type of error will obviously lead to incorrect Determinant Coding and therefore inappropriate response and patient care.

Both of the above causes can be better managed by consistently using case review feedback and continuing education to improve compliance (the third goal mentioned earlier). And it will soon become clear when there are any chronic non-compliers among the dispatch staff (those whose non-compliance doesn’t respond to feedback and education)—creating a predicable, and therefore preventable, risk.

Now consider what has changed in 2023, compared to 1990. Besides having a more advanced, contemporary protocol version, the biggest difference is the widespread use of ProQA® software as the de facto protocol standard, replacing the now outdated cardset (used strictly as a backup system). Given the profound difference between software and cardset systems, does the relationship between interrogation and Determinant Code compliance still hold when using the ProQA platform?

To answer this, one only needs to know that ProQA uses an internally tested, evidence-based logic system that depends on accurate answers to all the interrogation questions in the protocol to arrive at a recommended Determinant Code. Indeed, this compliance-based outcome accuracy relationship discovered by Dr. Clawson in the 1990 cardset version of the protocol is now stronger than ever in ProQA since it has been codified and refined over 30 years into a sophisticated, near artificial intelligence computerized logic system. In the world of computer logic, faulty input typically means an incorrect result. This enduring relationship is well worth reintroducing to all who have yet to discover it. We hope you enjoy this issue’s Blast from the Past.