Clinical Audits

SWORBHP’s Quality Assurance mandate includes the auditing and evaluation of paramedic practice to ensure patient care is delivered in accordance with the Advanced Life Support Patient Care Standards (ALS PCS).

Our goal is the provision of exceptional prehospital care and ensure both patient and paramedic safety in delivering that care and provide a mechanism to identify areas where improvement may be required. 


Mechanisms for Ambulance Call Report (ACR/ePCR) Review:

  • Automated Filtering Process – the data entered on each ACR/ePCR is evaluated by a series of computerized algorithms or filters based on medical directives looking for procedures performed or not performed but may have been indicated based on parameters such as vital signs. 
  • Self-Reporting – the paramedics involved in a patient encounter may use our SWORBHP Communication tools to identify occasions where patient care has varied from the medical directives, or for unusual occurrences or where clinical excellence has occurred.
  • External Inquiry – formal inquiries, requests for review or complaints may be received by SWORBHP by any number of parties, including, but not limited to:
    • Patient or family members
    • Paramedic/EMS Service Operators
    • Ministry of Health & Long-term Care
    • Allied Agencies
    • Receiving Hospitals


Clinical Audit Process (also see the flowchart):

  • First-Level Manual Audit
    • The call is reviewed by a member of the SWORBHP Professional Standards team, including either a peer reviewer or a Prehospital Care Specialist (PHCS)
    • If no variance is identified, the review of the call is closed with no further action taken.
    • If a possible variance(s) is identified, a PHCS will review the call, potentially in collaboration with a Local Medical Director (LMD).  If no variance is noted by the PHCS and LMD, the auditor is provided with feedback.
  • Audit Clarification
    • If a variance is noted by the PHCS and LMD, the paramedic will receive an email from the address noted above, requesting clarification on specific items.
    • This stage of the process is for clarification only and forms the basis of the remainder of the call review process.
  • Audit Response - see the audit response flowchart
    • After receiving an email from the audit team, paramedic response is required within 2 weeks, with provisions for delayed response due to extended vacation, leaves of absence or other extenuating circumstances.  Once the paramedic has provided their response to the request for clarification, the call review process proceeds.
    • If no response is received, the paramedic may face administrative deactivation until the matter can be resolved.
  • Call Review Process
    • The PHCS and LMD review the call including the paramedic response to request for audit clarification.  Additional information may include an evaluation of BHP patch forms, CACC patch tapes, cardiac monitor summaries and/or paramedic interviews (email, telephone or in-person).
    • The outcome of the review and any required follow-up will be communicated in writing to the paramedic via a closure letter for any outcome that resulted as a major or critical variance.  The most common outcome of these call reviews is for no variance to be assigned or for a minor variance, related either to patient care or documentation to be assigned.
  • Investigation Process
    • The investigation process closely resembles the call review process noted above; however, it is a more formal process utilized in the setting of a potential critical or complicated major variance.
    • Variances may be assigned with some form of remediation often being applicable to these occurrences. 


If you have any questions or concerns, please do not hesitate to contact the Quality Assurance team at 519-667-6718 or toll free 1-866-544-9882.