Organizational Overview

The Sunnybrook Centre for Prehospital Medicine, a division of Sunnybrook Health Sciences Centre (SHSC), is a multi-faceted, CQI-based organization responsible for certification, medical oversight, medical delegation, and development and delivery of continuing medical education (CME) for over 3,000 paramedics in south-central Ontario.

The Centre participates in local, national and international research projects and works in cooperation with seven Emergency Medical Services (EMS):

• Beausoleil First Nation Paramedic Services
• County of Simcoe Paramedic Services
• Halton Region Paramedic Services
• Muskoka Paramedic Services
• Peel Regional Paramedic Services
• Rama Paramedic Services
• Toronto Paramedic Services

The Centre for Prehospital Medicine oversees approximately 1/3 of all paramedics in Ontario, including both advanced and basic life support skill levels. In addition, the Centre also partners with 2,800 firefighters and emergency first responders at Toronto Fire Services and Ryerson University.

The Centre strives to improve not only individual paramedic practice but also system performance through the audit, case review, feedback, educational processes and use of the PCDA (Plan, Do, Check, Act) cycle. All processes are linked in a virtuous cycle in order to achieve our organizational goal: improving patient outcomes.

Performing clinical audits on each ambulance call is a critical component of the cycle as it provides the opportunity for continuous improvement, leading to change in: medical direction, research initiatives, individual or group practice and system design.

Clinical Auditing System

The clinical auditing system is an innovative method for performing clinical Quality Assurance (QA) audits. The system is fully web-based, allowing the Centre to audit 100% of all data in a timely, cost-effective and efficient manner. This process has allowed the Centre to audit approximately 470,000 Ambulance Call Reports (ACRs) yearly, in comparison to less than 10% of the same call volume using the previously employed paper auditing system. The time required to perform ACR audits and auditing costs has declined by more than 80% through the use of this new system.

Each clinical audit consists of data that is sorted and put through a series of filters which are computerized algorithms based on medical directives or other standards. The filters compare paramedic procedures with the directives and/or standards in order to identify variance in practice. For the purposes of the clinical audits, a variance is defined as a difference in practice when compared to a defined standard. These are not necessarily errors but each must be reviewed to determine its real or potential impact on patient care.

Clinical audit activities ensure the adherence to standards of practice as well as identifying the possible need for change either to the system, by the individual or by the delegating body. It significantly increases our ability to detect variances in clinical care and to effect improvement, resulting in both better patient care and EMS safety.

For more information, email Jim Summers, [email protected], Manager of Professional Standards and Compliance.