Comparison of two systems for quality assurance of prehospital advanced life support services

The need for quality assurance (QA) systems for review of prehospital advanced life support (ALS) care has long been recognized. However, there only have been limited published studies on the operation and cost of QA systems for prehospital care. A number of different systems currently are in use, and the relative effectiveness of different QA systems has not been well determined.

The aim of this study was to compare the personnel work-time and costs of two different systems of QA for prehospital ALS services, and thereby determine which type of system was more cost-effective in the generation of QA reports.

The quality assurance program (System 1) for three independent ALS services in a rural/suburban area and the QA program (System 2) for a nearby urban ALS service were compared. Data recorded included the training level and number of hours per year devoted exclusively to QA activities by different personnel. The annual costs for other aspects of the QA systems and apportioned salary costs for time spent on QA work were recorded.

System 1, a computer-based system, utilized 1,116 hours per year of personnel time and required [US]$17,662 in total costs per year (average cost per run reviewed of $4.38). System 2 (a manual system) utilized 569 hours per year of personnel time and had an annual cost of [US]$8,361 (or $2.15 per run reviewed). System 1 generated 852 reports per year (21% of runs) about non-compliance with protocols or charting deficiencies. System 2 generated 284 reports per year (7.3% of runs) for similar events.

Either a computer-based or "manual" system for QA of prehospital ALS services can be utilized. A computer-based system requires more personnel time and is more expensive, but generates more reports per year than does the manual system. A computer-based system more readily can retrieve run report data for further review.