As the Associate Director of Accreditation, I see many ACE and re-ACE applications every month. Point 10 of Accreditation is the “Academy verification of correct case review and QI techniques.” The Board of Accreditation reviewers and I are seeing a trend in how ED-Qs are scoring PDIs in AQUA® that could cause an artificially low score for the emergency dispatcher.
Of course, we want our emergency dispatchers to get all the credit they deserve, so here is a primer for ED-Qs on how to correctly score PDIs. Don’t skip this article, emergency dispatchers; you will want to know this information so you can check to make sure your calls are being reviewed correctly.
Let’s start with some background information. In the current programming, everything in the PDI section of ProQA® gets uploaded into AQUA. This means that all Critical Emergency Dispatcher Info and all headers and emergency dispatcher instructions are imported into AQUA along with the actual PDIs.
Why does this matter? It is a simple matter of denominators. PDIs are scored as the number of correctly given PDIs out of the total number of possible PDIs. If the ED-Q™ doesn’t use the radio button in AQUA correctly, the score can be skewed.
How can this happen? Incorrectly scoring PDIs as N/A (Not Applicable). If N/A is selected, it takes that item out of the scoring. You only want to do this for items that are truly not a PDI. These are only those things that are for the emergency dispatcher and are not instructions for the emergency dispatcher to give to the caller.
If other parts of PDIs are scored as N/A—such as instructions that are excluded by a Pre-Instruction Qualifier—then the denominator is artificially lowered. Why does this matter? If items are taken out (by marking them N/A) that should be counted, then the denominator is reduced. If there is one PDI that was not given, it could mean the difference between 3/4 (major deviation) and 8/9 (minor deviation). For the same one mistake.
You can see how as an ED-Q it is vitally important to correctly score PDIs in AQUA. As an emergency dispatcher it is equally important to know this to ensure your cases are being reviewed correctly. In this one example, it is the difference between a Partial Compliant case versus a Compliant case.
Do I have your attention now? Great! Here is how to do it right.
Scoring PDIs
In PDIs, the ED-Q will select the radio button that corresponds with the legend. There are 5 available options for measuring an instruction: Given Correctly, Not Given, Given Incorrectly, N/A, and Obvious. (Not as Scripted (NAS) is not measured as part of PDIs.)
- Given Correctly: Instruction is appropriate and emergency dispatcher correctly gives the instruction.
2. Not Given: Instruction is appropriate and possible, yet emergency dispatcher does not give it. There is a deviation for this.
3. Given Incorrectly: Emergency dispatcher gives the instruction but changes the meaning/intent or gives an instruction that is inappropriate for the situation or that is excluded by a Pre-Instruction Qualifier (PIQ). There is a deviation for this.
4. Not as Scripted (NAS) is not used in PDIs. If an instruction is given not as scripted but does not change the meaning or intent, it is measured as correct.
5. N/A: This is used for all information that is provided to the emergency dispatcher and not intended to be read to the caller: headers, CEIs, Chief Complaint specific instructions for the emergency dispatcher, and direction to use diagnostic tools, etc. This is NOT used for instructions the emergency dispatcher correctly did not give.
6. Obvious: This is used when it is obvious that the emergency dispatcher does not need to give the instruction.
Examples:
- Instruction is excluded by a PIQ, and the emergency dispatcher correctly does not give it. For example, if a tourniquet was not applied one should not give the (Tourniquet already applied) instruction.
- Instruction is not appropriate for the situation (Put away the pets at a shopping mall).
- Smart PDIs: These are grayed in ProQA but are available if required.
Obvious is used in these situations because we want to give the emergency dispatcher credit for their thought process. The emergency dispatcher had to look at the instruction and decide whether it was appropriate to give. Just as we would score an instruction as given incorrectly if they gave an instruction that was inappropriate or excluded by a PIQ, we give credit when they correctly don’t give it.
To help you remember this, “It was obvious they didn’t need to say it.”
Special discussion on N/A
Marking an instruction N/A takes the instruction out of the denominator for the total possible instructions. If N/A is misused, it will result in the emergency dispatcher not getting credit for instructions that were part of their calltaking thought process.
In the example below:
5 instructions were given correctly (1)
1 instruction was not given (2)
1 instruction was given incorrectly (3)
4 instructions are N/A because it is information for the emergency dispatcher not the caller (5)
2 instructions were obvious because they were correctly not given (6)
The final score is 7/9 = Moderate
If the obvious question was scored instead as N/A, the final score would be
5/7 = Major
Special discussion of Arrival Interface H99
H99 Arrival Interface is available for use on any call. Due to ProQA architecture, it is imported into AQUA as a PAI, yet is considered a PDI. It must be recorded in the PAI box as it can’t be moved down to the PDI box, yet when measuring the arrival interface, use the standards for evaluating PDIs. DLS Standard 2 on PDIs will be applied to this instruction. “The calltaker will read Post-Dispatch Instructions … as scripted but may enhance Post-Dispatch Instructions with situational or conditional statement as long as the meaning or intent of the instruction is kept intact.”
What now?
Scoring PDIs in AQUA correctly can impact both individual performance and agencywide ACE performance. Using the “rules” above to score PDIs can, in some cases, dramatically improve the score in this section.
If you are an emergency dispatcher, take the time to speak to someone in your Quality Improvement Unit to ensure they have this information and are scoring cases correctly. While you are there, take the time to ask any other questions you may have. ED-Qs are a wealth of knowledge.
If you are the ED-Q, don’t be concerned if you need to change your ways. You do not need to go back and redo all the calls you have already reviewed. Going forward you can apply these principles. Isn’t it great when we find out how to make our ED-Q practices more accurate and in turn improve scoring?
