Part of the Clinical Audit process undertaken by quality assurance staff, is incident analysis to better appreciate what if any variances from documented standards may have occurred in delivering patient care.
The goal in identifying these variances is identify the root causes of these variances with an eye to improving the prehospital care system for both patients and paramedics. Variances may be the result of the paramedic making either an omission (a lack of action) or a commission (an action) in the delivery of patient care.
In classifying variances, as the call review or investigation process is completed, the paramedic will receive written notification of any variances assigned in a closure letter.
Minor Variance – Patient Care
An omission (lack of action) or commission (action) by the paramedic that did not have any direct effect on patient morbidity or outcome however may have impacted patient care in a minor way or have been inconsistent with the Medical Directives/ALSPCS.
Minor Variance – Documentation
This variance is assigned when the paramedic omits information from the ACR/ePCR which is required to rationalize the treatment provided or withheld from a patient.
For example, not documenting the patient had a previous history of prescribed nitro use prior to administering nitro to a patient without an IV established.
An omission (lack of action) or commission (action) by the paramedic that affected or had the potential to affect patient outcome or morbidity, however the outcome would not be life-threatening.
A critical variance may be the omission (lack of action) or commission (action) by the paramedic that has a clear effect on patient outcome or morbidity with the actual or realized potential to be life-threatening.
The performance of a Controlled Act(s) for which you have not been certified would fall under the category of critical variance.