I started my emergency dispatch career in 2004. In 2014, I became the EMD Quality Performance Improvement Coordinator and since then, my career has been dedicated to quality improvement. I was sitting in my office one day wondering why I continued to hear the same mistakes being made repeatedly. Not only was I seeing this occur with the agency I worked for, but I was also hearing it from other agencies. Similar questions were being posted on the International Academies of Emergency Dispatch’s (IAED™) “True 2 Q” Facebook page. I quickly learned the challenges we were having were not anomalies.
It’s easy to point fingers when something isn’t working, and doing mounds of case review can make you lose sight of the bigger picture. The normal feedback process wasn’t working. I couldn’t keep writing the same thing and having the same conversations. I had to do more. Quality improvement shouldn’t just be focused on the performance of the Emergency Dispatchers.
We should take an overall quality assurance approach and look at all the factors that can contribute to non-compliance. When something is broken, open your mind, research the problem further, and ask yourself why. While sometimes the answer is to provide more training, sometimes the answer may be that the process needs adjusting.
It was easy for me to point out the consistent errors I was seeing within the reviews I was doing. They stuck out like a sore thumb. While we had access to our own agency’s data, I needed to know what other Accredited Centers of Excellence (ACE) were reporting. I reached out to Kim Rigden, IAED Associate Director of Accreditation, and asked her if there was data available that showed the deviation trends from other ACEs. What are the top protocols that agencies most frequently struggle with? What Key Questions cause the most problems? What instructions do they stumble with most?
Outside of the ACE report, specific data on what protocols, questions, and instructions were causing the deviations was not available to answer my questions. Unless it’s brought up in conversation, the specific struggles remain unknown. So Kim put me in touch with the IAED research team. My mind was going in a thousand directions as I piled on mountains of questions during the meeting.
Dr. Chris Olola, Ph.D., Director of Research & Informatics, and Greg Scott, MBA, Associate Director of Protocol Evolution, were patient as I pointed out areas of the protocol that Emergency Dispatchers have trouble conquering. The big question was, “Why are we seeing multiple dispatchers have the same struggles within MPDS®?”
One protocol caught my attention the most during EMD case review. On Protocol 26: Sick Person (Specific Diagnosis), I noticed three areas that needed improvement: Chief Complaint selection, ALTERED LEVEL OF CONSCIOUSNESS descriptors selection, and ALPHA-level NON-PRIORITY Complaints.
We needed to investigate these areas further and see what we could do to make these concepts easier and more straightforward for our Emergency Dispatchers. If we can define these trends, we can determine at the agency level whether further education needs to be created and provide clarity within the protocol. To benefit other agencies, we can submit Proposals for Change (PFCs) regarding the wording of a question or an answer choice in the protocol.
Toward the end of our conversation, Greg suggested I do a research project that I would present at NAVIGATOR, if selected. My heart immediately started to race, my hands got clammy, and my face turned red. I’ve never done this before. I’m not comfortable with public speaking. But I couldn’t let fear take over; I had to let my passion guide me. And knowing that I had a team at the IAED to support me in the process made it easier for me to jump on board. I accepted the challenge.
The first step was to compile structured quantitative data. It would take some time to reach out to other agencies and ask them to share their data, so we decided to start by gathering data from the agency that I worked for. Pulling the data was the easy part. The quality assurance software, AQUA®, made it easy to export data on the areas of discrepancies (i.e., deviations) into a spreadsheet. We used this data to find the top protocols and the specific errors that occurred within each protocol. Graphs were created and a template was provided so I could create the poster.
My biggest piece of advice would be don’t approach the project with the expectation that all your questions will be answered. Sometimes you may find that the research takes a different turn or more needs to be done before you can reach a result. This poster did just that. While it gave us the foundation needed to take the next step in quality improvement, it gave us one piece of the pie. More research needs to be done. That’s the fun in it all. It keeps our intriguing minds thinking of what should happen next based on what we’ve learned and what we still want to know.
While it was intimidating at first, that feeling was replaced with inspiration and satisfaction. Knowing I was able to take my passion and ideas and instill it in others was gratifying. While we may not work together, we are all on the same journey. Everyone has something they want to know about or need a solution for.
Sharing knowledge with each other is a vital piece of success. Doing a research poster is one way to provide information to others while also receiving beneficial feedback that can help you put together a research study. If you have a research idea, suggest it to the IAED research team. They will give you the tools you need and help you through any roadblocks you may hit. Don’t let the detours change your route because in the end you will find that the road traveled was worth it!
