Auditing Process

Mechanisms for Ambulance Call Report (ACR/ePCR) Review:

Automated Filtering Process – The data entered on each call report is evaluated by a series of computerized algorithms or “filters”. The filters scan each call for various key indicators associated with documented vital signs and procedure codes, all of which are built around the most recent ALS PCS medical directives. When the documented patient care does not meet the predefined criteria, the call report will be sent to a prehospital care specialist for an eyes-on/manual review.

Self-Reporting – The paramedics involved in a patient encounter may use our SWORBHP Communication tools to identify occasions where patient care has varied from the medical directives. These tools may also be used for unusual occurrences or situations where clinical excellence has occurred.

External Inquiry – Formal inquiries, requests for review, or complaints may be received by SWORBHP by any number of parties, including, but not limited to:

  • Paramedics/EMS Service Operators
  • The Ministry of Health & Long-Term Care
  • Allied Agencies
  • Receiving Hospitals

Clinical Audit Proces

First-Level Manual Audit

If the call has been identified as having a possible omission/commission in care, a Prehospital Care Specialist (PHCS) will be assigned to perform a peer review and clinical audit.

If no variance is identified, the review of the call is closed, with no further action taken.

If a possible variance(s) is identified, the call will then be escalated to a Second-Level auditor for further consultation and review. At times, collaboration with a Local Medical Director (LMD) may also be required during this process.

If a variance is noted by the PHCS and LMD, the paramedic will receive an email with the subject Audit Clarification/Feedback Request from [email protected]. This email will be requesting clarification on specific items. Once logged in, you will see a tab at the top of the page titled ACR. Please feel free to review the redacted ACR prior to responding.

After receiving an email from the audit team, a paramedic response is required within two weeks, with provisions for delayed response due to extended vacation, leaves of absence, or other extenuating circumstances. Once the paramedic has provided their response to SWORBHP for the request for clarification, the call review process proceeds.

This stage of the process is for clarification only and forms the basis of the remainder of the call review process.

If no response is received, the paramedic may face administrative deactivation until the matter can be resolved. Please refer to the Audit Process Flowchart further down on this page for more information.

Call Review Process

The PHCS and LMD review the call, including the paramedic’s response to the request for audit clarification. Additional information may include an evaluation of BHP patch forms, CACC patch tapes, cardiac monitor summaries and/or paramedic interviews (email, telephone or in-person).

The outcome of the review and any required follow-up will be communicated in writing to the paramedic via a closure letter for any outcome that resulted in a major or critical variance. The most common outcome of these call reviews is for no variance to be assigned or for a minor variance, related either to patient care or documentation to be assigned.

Investigation Process

The investigation process closely resembles the call review process noted above; however, it is a more formal process utilized in the setting of a potential critical or complicated major variance.

Variances may be assigned with some form of remediation often being applicable to these occurrences.

If you have any questions or concerns, please do not hesitate to contact the Quality Assurance team at 519-667-6718 or toll-free 1-866-544-9882.

Auditing Process Flowchart

Auditing process flowchart

Variance Definitions

Part of the Clinical Audit process undertaken by quality assurance staff is incident analysis to better appreciate what, if any, variances from documented standards may have occurred in delivering patient care.

The goal in identifying these variances is to identify the root causes of these variances with an eye to improving the prehospital care system for both patients and paramedics. Variances may be the result of the paramedic making either an omission (a lack of action) or a commission (an action) in the delivery of patient care.

In classifying variances, as the call review or investigation process is completed, the paramedic will receive written notification of any variances assigned in a closure letter.

Minor Variance – Patient Care

An omission (lack of action) or commission (action) by the paramedic that did not have any direct effect on patient morbidity or outcome, however, may have impacted patient care in a minor way or have been inconsistent with the Medical Directives/ALS PCS.

Minor Variance – Documentation

This variance is assigned when the paramedic omits information from the ACR/ePCR, which is required to rationalize the treatment provided or withheld from a patient.

For example, not documenting the patient had a previous history of prescribed nitro use prior to administering nitro to a patient without an IV established.

Major Variance

An omission (lack of action) or commission (action) by the paramedic that affected or had the potential to affect patient outcome or morbidity, however, the outcome would not be life-threatening.

Critical Variance

A critical variance may be the omission (lack of action) or commission (action) by the paramedic that has a clear effect on the patient outcome or morbidity with the actual or realized potential to be life-threatening.

The performance of a Controlled Act(s) for which you have not been certified would fall under the category of critical variance.

Related Links

Medical Directives Icon

Quality Assurance Overview