Performing a QA/QI Review
Purpose Statement
The EMS QA/QI Review Process enables supervisors and quality assurance reviewers to systematically evaluate patient care reports for accuracy, completeness, and compliance with organizational standards. This structured workflow facilitates communication between reviewers and report authors, ensures documentation quality, maintains regulatory compliance, and provides a feedback mechanism that improves patient care documentation across the organization. By standardizing the review process, departments can identify trends, address training needs, and maintain high-quality EMS documentation standards.
Background Information
Quality assurance and quality improvement (QA/QI) are critical components of modern EMS operations, ensuring that patient care reports meet clinical, legal, and regulatory standards. The First Due EMS QA/QI process creates a structured review cycle that begins when EMS providers select "Request Supervisory Review" during documentation completion.
How Reports Enter QA/QI Workflow:
Reports enter the QA/QI list automatically when providers select "Request Supervisory Review" during the documentation process. This field triggers a workflow that moves the completed report into the QA/QI queue for supervisor assignment and review.
An incident displayed in the QA/QI list will have 1 of 5 possible statuses:
- Not Started - The report has been completed by the EMS provider and sent to the QA/QI list via a workflow. No comments have been saved by any reviewer.
- Review In Progress - When comments are made, but report author review has not yet been requested.
- Waiting - When the supervisor/QA Person is waiting on the report author to review/make changes to resolve issues.
- Pending - When the QA/QI review is sent back to the supervisor/QA person.
- Review Complete/Approved - The QA/QI process has been completed.
Required Permissions
ePCR Permissions:
- List My QA/QI EMS Incidents (view assigned/unassigned records)
- List All QA/QI EMS Incidents (view all records regardless of assignment)
- Assign EMS Reports to QA/QI Reviewers (assign reviewers to reports)
- List view management permissions (filter and customize display)
Video
Step-by-Step Guide
Initial Review
1. Navigate to Incident Documentation - EMS QA/QI.
2. Select one or more reports, then click on "Assign To".
3. PCRs need to be assigned to at least one reviewer before a review can begin.
4. Use the filter tools across the top of the QA/QI list to adjust the displayed incidents. Saved Views can be used after filter and column preferences are set.
5. If you are an assigned reviewer for an Incident, the "Review" button will be displayed in the Actions Column. Click to begin or continue a review.
6. Hover over any field and click on the comment icon to leave a comment for the selected field.
7. Choose what type of message to send, Red (error), Yellow (warning) or Green (well done), then type a comment in the text box.
The Green comments will not require any type of Approve or Resolve workflow.
8. Click on the "Send Comment" button to save the comment and continue reviewing.
9. Click on "Comments" to view a summary of all comments submitted for the incident.
10. Click on Request Review to complete your initial review and notify the report author that that their review is needed.
The report author will receive an email notification of the review request with a hyperlink to the ePCR. The incident status will change to "Waiting."
Approve/Deny Process
11. When the crew member has finished reviewing and updating the ePCR and resubmitted the report, the QA Status will change to "Pending".
Click on the Review button to approve/deny any updates from the crew member.
12. Approve or Reject individual field changes from the crew member.
Rejecting an edit or comment will result in the report changing back to "Waiting" status and the report author being notified of an additional review request.
13. Alternatively, use the comments section on the right side of the screen to view/approve all changes.
14. Click on Approve to finalize the QA/QI process. This will change the QA/QI status to "Approved" in the QA/QI list.
Best Practices
For QA/QI Reviewers and Supervisors:
- Establish and document your department's QA/QI standards and apply them consistently across all reviews
- Use a checklist or standardized review criteria to ensure you evaluate all reports using the same standards
- Review reports in a timely manner - aim to complete initial reviews within 24-48 hours of assignment
- Set aside dedicated time each shift or day for QA/QI reviews rather than trying to review reports sporadically
Providing Effective Feedback:
- Be specific and constructive in all comments - focus on education rather than criticism
- Use error (red) comments sparingly and only for genuine compliance or critical documentation issues
- Balance corrective feedback with positive reinforcement using well done (green) comments when providers demonstrate excellent documentation
- Explain the "why" behind corrections - help providers understand the clinical, legal, or regulatory reasoning
- Provide examples of correct documentation when pointing out errors
- Maintain a professional, educational tone in all feedback
Communication and Follow-Up:
- Respond promptly when reports return to "Pending" status to maintain workflow momentum
- If multiple review cycles are needed, consider a phone call or in-person discussion for complex issues
- Track patterns across multiple reports from the same provider to identify training opportunities
- Document positive trends and improvements you observe over time
Workflow Management:
- Create and use saved views to organize your queue by priority, provider, or status
- Batch similar reviews together for efficiency (e.g., review all reports from new providers in one session)
- Don't let reports languish in "Waiting" status - follow up if authors haven't responded within a reasonable timeframe
- Balance thoroughness with efficiency - focus on significant issues rather than minor stylistic preferences
Educational Approach:
- View QA/QI as a teaching opportunity rather than a punitive process
- Identify trends across multiple reports that indicate department-wide training needs
- Share excellent documentation examples (de-identified) with the team to set standards
- Consider following up exceptional reviews with personal recognition or commendations
For Report Authors Receiving QA/QI Feedback:
Responding to Review Requests:
- Check your email regularly for QA/QI review notifications
- Address feedback promptly - don't let reports sit in "Waiting" status for extended periods
- Read all comments carefully before making changes to understand the full scope of requested revisions
- Use the comment thread to ask clarifying questions if reviewer feedback is unclear
Making Quality Corrections:
- Address every comment, even if just to acknowledge feedback on positive (green) comments
- Don't just make minimal changes - ensure your revisions fully address the reviewer's concerns
- If you disagree with feedback, document your clinical reasoning in the response rather than ignoring the comment
- Double-check your changes for accuracy before resubmitting
Learning and Improvement:
- View QA/QI feedback as professional development rather than criticism
- Track recurring feedback themes in your own documentation to identify personal improvement areas
- Apply lessons learned from one review to future documentation to reduce repeated issues
- Seek additional training or clarification if you receive consistent feedback on specific documentation areas
Professional Communication:
- Maintain professional communication in all responses to reviewer comments
- If frustrated by feedback, take time to process before responding emotionally
- Thank reviewers for thorough feedback and recognition of good documentation
- Use the review process to build rapport and communication with supervisors
Troubleshooting & FAQs
Access and Permission Issues
Q: I can't see the EMS QA/QI option in my Incident Documentation menu
- Verify you have been assigned appropriate QA/QI permissions by your system administrator
- Confirm you have at least "List My QA/QI EMS Incidents" permission enabled
- Log out and log back in to refresh your permission settings
- Contact your First Due administrator if the option still doesn't appear after confirming permissions
Q: I can see reports in the QA/QI list but there's no "Review" button in the Actions column
- The "Review" button only appears for reports that have been specifically assigned to you
- Check the "Assigned To" column to verify you're listed as a reviewer for that report
- If you have "List All QA/QI EMS Incidents" permission, you can see all reports but can only review those assigned to you
- Ask a supervisor or administrator with assignment permissions to assign the report to you
Q: I assigned myself to a report but still don't see the Review button
- Try refreshing your browser (F5 or Ctrl+R)
- Clear your browser cache and log back in
- Verify the assignment saved successfully by checking the Assigned To column
- If the issue persists, log out completely and log back in to refresh your session
Assignment and Workflow Issues
Q: Can I assign a report to multiple reviewers?
Yes, you can assign reports to multiple reviewers during the assignment process
Each assigned reviewer will receive notifications and can conduct independent reviews
This is useful for training new QA/QI reviewers or for complex cases requiring multiple perspectives
However, coordinate among reviewers to avoid duplicate or conflicting feedback
Q: What happens if I accidentally click "Request Review" before I'm finished?
The report will immediately move to "Waiting" status and notify the report author
You cannot add additional comments once the report is in "Waiting" status
Wait for the author to respond and resubmit the report to "Pending" status
When it returns to you, you can add any additional comments you missed initially
Alternatively, contact the report author directly to hold off on making changes while you add remaining comments through another review cycle
Q: A report has been in "Waiting" status for several days with no response from the author
Check that the report author received the email notification (verify email address accuracy)
Contact the report author directly via phone, radio, or in-person to remind them of the pending review
Some departments set policies for maximum time in "Waiting" status (e.g., 5 business days)
Work with your supervisor to establish escalation procedures for overdue responses
Consider whether the provider is on vacation, leave, or otherwise unavailable
Q: Can I reassign a report to a different reviewer after it's already been assigned?
Yes, you can reassign reports at any point in the review process if you have assignment permissions
Select the report and click "Assign To" again, then choose the new reviewer
Consider adding a note to any existing comments explaining the reassignment to maintain continuity
The new reviewer will see all previously submitted comments and review history
Comment and Review Issues
Q: I can't find the comment icon when hovering over fields
Ensure you've clicked the "Review" button and opened the report in review mode rather than just viewing it
Some fields may not be commentable depending on field type or configuration
Try hovering more slowly or precisely over the field in question
Check that you have the necessary review permissions
Try a different browser if the issue persists (Chrome and Firefox are recommended)
Q: I submitted a comment but don't see it in the Comments panel
Verify you clicked "Send Comment" to save the comment rather than just typing it
Refresh the Comments panel by closing and reopening it
Check your internet connection - if you're offline, comments may not save properly
Look in the specific field you commented on to see if the comment icon shows a saved comment
Q: Can I edit or delete a comment after I've submitted it?
Once submitted, comments generally cannot be edited or deleted to maintain audit trail integrity
If you made an error, you can submit an additional comment clarifying or correcting your previous feedback
Contact your system administrator if you need to remove an inappropriate or erroneous comment
Be careful to review comments before clicking "Send Comment" to avoid this issue
Q: What's the difference between using red (error) vs. yellow (warning) comments?
Red (Error): Use for critical issues that must be corrected for compliance, patient safety, or legal documentation requirements - these indicate non-negotiable corrections
Yellow (Warning): Use for improvements, suggestions, best practices, or minor issues that should be addressed but aren't critical failures
Use red comments sparingly to preserve their impact for truly serious issues
Yellow comments are better for educational feedback and continuous improvement items
Q: Should I use green (well done) comments?
Absolutely! Positive reinforcement is a powerful educational tool
Use green comments to acknowledge excellent documentation, proper protocols, thorough narratives, or any exemplary work
Balance corrective feedback with recognition to maintain morale and motivation
Green comments don't require approval workflow, so they're purely for positive feedback
Providers appreciate knowing what they're doing right, not just what needs correction
Status and Approval Issues
Q: The report is in "Pending" status, but I don't see what changes the author made
Ensure you're opening the report using the "Review" button rather than just viewing it
Modified fields should be highlighted or marked in the review interface
Check the Comments panel to see responses from the report author
If changes still aren't visible, try refreshing your browser or clearing cache
Contact technical support if the issue persists
Q: I approved all changes, but the status didn't change to "Approved"
Verify you clicked the final "Approve" button after approving individual changes
Check that you approved all pending comments - any outstanding comments will prevent final approval
Review the Comments panel to ensure no comments remain in "Pending" status
If all comments show as approved but status doesn't update, refresh your browser
Log out and log back in if the issue continues
Q: I rejected a change but want to approve it now - how do I fix this?
Once a rejection is submitted, the report returns to "Waiting" status for the author to address
Wait for the author to resubmit the report with additional changes
When it returns to "Pending" status, you'll have another opportunity to approve
Consider contacting the author directly to explain your change of mind to avoid confusion
Q: Can I partially approve a report if only some issues are resolved?
No, the approval process is all-or-nothing for final completion
If some issues are resolved but others aren't, reject the items still needing work
The report will return to "Waiting" status with specific feedback on what still needs correction
You can approve resolved items individually while rejecting others
Final "Approved" status only happens when all issues are satisfactorily resolved
Technical Issues
Q: The QA/QI list isn't loading or displays an error
Check your internet connection
Try refreshing the page (F5 or Ctrl+R)
Clear your browser cache and cookies, then try again
Try accessing from a different browser (Chrome, Firefox, Edge, Safari)
Log out completely and log back in
Contact First Due support if the issue persists across browsers and devices
Q: Email notifications aren't being sent to report authors
Verify the report author's email address is correct in their user profile
Check spam/junk folders - First Due notifications may be filtered
Confirm email notifications are enabled in system settings
Test with a different user to determine if it's a system-wide or individual issue
Contact your system administrator to verify email server configuration
Q: My saved views disappeared or aren't working properly
Saved views are tied to your user account - verify you're logged in with the correct credentials
Try recreating the saved view with your preferred filters and columns
Clear browser cache if saved views aren't loading properly
Check with your administrator if saved views were recently reset or modified system-wide
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