Assuring Quality in the EMS System: Credentialing EMS ... Me… · John M Gallagher, MD Winona Area...
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John M Gallagher, MD Winona Area Ambulance Service 1 John M Gallagher, MD, FAEMS EMS Director/Medical Director Wichita/Sedgwick County Kansas Credentialing EMS Providers Assuring Quality in the EMS System: @JGallagherEMS • Conflicts: – None • Disclosure: – NAEMSP credentialing position paper lead author – NAEMSP BOD
Transcript of Assuring Quality in the EMS System: Credentialing EMS ... Me… · John M Gallagher, MD Winona Area...
John M Gallagher, MDWinona Area Ambulance Service
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John M Gallagher, MD, FAEMSEMS Director/Medical Director
Wichita/Sedgwick County Kansas
Credentialing EMS Providers
Assuring Quality in the EMS System:
@JGallagherEMS
• Conflicts:– None
• Disclosure:– NAEMSP credentialing
position paper lead author
– NAEMSP BOD
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If I picked a name at random from your provider roster…
…would you stake your career on their performance abilities?
National EMS Scope of Practice:
Need a copy of the document?
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• National EMS Scope of Practice:– “...where all the four elements overlap, represents skills
and roles for which an individual has been educated, certified, licensed by a State, and credentialed.”
– “This is the only acceptable region of performance, as it entails four overlapping and mutually dependent levels of public protection: education, certification, licensure, and credentialing.”
• National EMS Scope of Practice:– “...where all the four elements overlap, represents skills
and roles for which an individual has been educated, certified, licensed by a State, and credentialed.”
– “This is the only acceptable region of performance, as it entails four overlapping and mutually dependent levels of public protection: education, certification, licensure, and credentialing.”
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The First Three Domains
• Entry level competence is achieved through accredited education programs
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• National certification = attestation to entry level competence of knowledge, skills, and abilities
• State licensure = the privilege to practice in the specific profession
• However, these processes do not ensure readiness to work at a specific organization
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• A quick aside:– The domains needed for clinical practice…
Domain: Physician: EMS:
AccreditedEducation
LCME/ACGME &AMA PRA Cat 1
CoAEMSP/CAAHEP & CAPCE
Certification ABEM NREMT
Licensure Medical License State license/certificate
Local Oversight Hospital Privileges Medical Director Credentialing
• A quick aside:– The domains needed for clinical practice…
Domain: Physician: EMS:
AccreditedEducation
LCME/ACGME &AMA PRA Cat 1
CoAEMSP/CAAHEP & CAPCE
Certification ABEM NREMT
Licensure Medical License State license/certificate
Local Oversight Hospital Privileges Medical Director Credentialing
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Credentialing
(The Fourth Domain)
• Credentialing is attestation by an organization’s EMS physician medical director that the EMS provider possesses required competencies
• Both initial and ongoing assessments are important components
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• Credentialing at a minimum involves:– Cognitive knowledge
– Mature, responsible affective ability
– Psychomotor skills
– Integration of the above in critical thinking towards application of clinical care
Design
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Fair, consistent, objective
Feedback
Remediation
Additional attempt(s) if and when reasonable
Continuous review…...adaptive
Identify systemic knowledge or skill gaps in an
organization
• The medical director may choose to:– Establish requirements apart from
governmentally-regulated EMS scopes of practice…that may or may not be more restrictive
– Establish different competencies for initial vs continued credentialing (“re-credentialing”)
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• Credentials may be granted for differing lengths of time…however...
• Credentials may be granted for differing lengths of time…however...
• “The public is best served when re-verification...occurs no less frequently than every two years.”
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• Credentialing substantively helps to promote the practice of EMS medicine on par with the legitimacy that hospital medical staff credentialing promotes the practice of hospital-based medicine.
So what might this look like in the real world?
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What might this look like?
• Matched to the service or system:
– Performed directly by the Medical Director?
– Performed through delegated staff?• Who can be delegated?
– Staff under the Medical Director?
– Uncredentialled supervisors?
– Supervisors with lower credentialing?
What might this look like?
Cognitive knowledge:– Written test?
• Home grown?
• Purchased sitting?
• Subscription based (intact exam vs question bank)?
– Protocol test?
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What might this look like?
• Psychomotor skills– Classroom (skills day)?
– Simulation Center?
– Direct observation in the field?
– Logs?, charting databases?
What might this look like?
• Integration of critical thinking in the application of EMS Medicine:– Case reviews?
– Simulation Center?
– M&M?
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What might this look like?
Well...
"If you've seen one EMS system..."
If you want to see what my process looks like, here’s a
copy:
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Credentialing
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Your Score: 68%
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Feel free to use…your
mileage may vary.
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Other things that would probably benefit from
credentialing…
Staff who provide OLMC?
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Surgical Emergency Response Teams (SERTs)?
Final Bullet:
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• “The public is best served when EMS providers receive externally accredited education, are nationally certified, state or provincial licensed, and when credentialed by the local EMS physician medical director.”
• “The public is best served when EMS providers receive externally accredited education, are nationally certified, state or provincial licensed, and when credentialed by the local EMS physician medical director.”
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Take home points…
Take home points…
• Credentialing has been given importance on par with initial education, certification, and licensure.
• We now have defined best practices and expectations
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Take home points…
• Occur not less frequently than every 2 years
• All types of services and organizations need to credential under the medical director
• Needs to include assessment of cognitive knowledge, affective abilities, psychomotor skills, and critical thinking
Take home points…
This is in line with our peers throughout the healthcare industry and promotes the movement towards our growing acceptance as a medical sub-specialty.
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Questions?
John M Gallagher, MD, FACEP, FAEMS
Emergency and EMS Physician
My full contact info
@JGallagherEMS
