What is the difference between quality assurance and quality improvement in EMS?

Quality assurance (QA) measures compliance with a protocol, process, or policy — did the crew do and document the right things. Quality improvement (QI) is the broader, continuous process of making system-level changes and re-measuring to improve care over time. QA tells you where you stand; QI changes the system. Effective QI programs are non-punitive, transparent, and built on key performance indicators.

How can an EMS agency improve chart accuracy?

Combine a non-punitive QI culture, clear key performance indicators, structured documentation checklists, and — most powerfully — review against objective ground truth such as monitor data and body-camera footage, rather than relying on the crew's written narrative alone.

How to Improve EMS QA and Chart Accuracy

Q: How accurate is EMS documentation?

Studies consistently find significant gaps between what happens on a call and what gets charted. One study of 100 prehospital rapid-sequence intubations found that only 6% of patient care reports matched the video record on every quality measure tracked, and a simulation study found 39–42% of performed actions were documented incompletely or incorrectly.

Every EMS quality program runs into the same wall: the patient care report is written from memory, after the call, by a clinician who was managing a patient — not taking notes. This guide covers how to build a quality program that actually moves chart accuracy, grounded in the EMS QI literature.

First, separate QA from QI

These terms get used interchangeably, and that confusion stalls programs. Per the EMS Quality Improvement Programs review in StatPearls:

Quality assurance (QA) is about compliance — did the crew follow the protocol, process, or policy, and document it.
Quality improvement (QI) is the intentional, continuous process of making system-level changes and re-measuring to improve care.

QA is a snapshot; QI is the engine. The most important finding in that literature: QI works best in a non-punitive, transparent environment. If chart review feels like a hunt for someone to discipline, your data quality gets worse, not better, because crews chart defensively.

The accuracy problem, in numbers

The reason chart review matters is that prehospital documentation drifts from reality more than most leaders assume:

A study of 100 consecutive prehospital rapid-sequence intubations compared the written PCR to the video record. Only 6% of charts matched the video on every quality measure. The largest discrepancies were time-to-intubate (58%), number of attempts (36%), and first-pass success (24%).
A German EMS simulation study found 39–42% of the actions crews performed were documented incompletely or incorrectly.
A pilot study concluded that “current EMS documentation practices demonstrate significant inaccuracy regardless of years of experience” — and that body-worn cameras significantly improved accuracy.

This is not a competence problem. It is a memory-under-stress problem, and seniority does not fix it. Inadequate documentation is not just a paperwork issue, either — it has been associated with increased in-hospital morbidity and mortality.

A four-part playbook

1. Run real PDSA cycles

Most effective EMS QI programs use the Plan-Do-Study-Act cycle from the Institute for Healthcare Improvement. Pick one specific, patient-centric aim (“aspirin documented in 95% of suspected ACS patients”), change one thing, measure, and iterate. Include field crews in the cycle — not just the medical director’s office.

2. Define KPIs you can actually measure

Build key performance indicators on clinical evidence, a known system deficit, or an operational need. Make them specific and numeric. A 2015 national survey found 71% of EMS agencies report dedicated QI personnel — but a person without clear KPIs just generates opinions.

3. Use structured documentation aids

Checklists and structured templates work. A collegiate EMS agency that revised its documentation checklists measurably improved the inclusion of key documentation criteria on ePCRs. Tie your templates to the NEMSIS elements that matter for your call types so completeness and compliance move together.

4. Review against ground truth, not the narrative

This is the highest-leverage change. If your QA reviews grade the chart against itself — or against the crew’s recollection — you can only catch internal inconsistencies. When you grade against objective ground truth (cardiac-monitor data, CAD timestamps, and body-camera footage), you see what actually happened. That is the difference between auditing the chart and auditing the call.

From sampling to seeing every call

Traditional QA reviews a small sample — often around 10% of calls — because manual review is expensive. The constraint is labor, not value. If reconciling the record were automatic, there would be no reason to stop at a sample.

That is the model VeriMedic CaseSync is built on. CaseSync reconciles body-camera video, monitor data, and CAD onto one synchronized timeline, drafts the NEMSIS fields into your existing ePCR for the crew to confirm, and lets reviewers grade calls against that objective timeline. It does not replace your QA program — it changes what the QA is built on: the call, not the chart written afterward.

Frequently asked questions

What’s the difference between QA and QI? QA measures protocol/process/policy compliance; QI is the continuous, non-punitive process of changing the system and re-measuring.

How accurate is EMS documentation? Often poor against an objective record — one RSI study found only 6% of charts matched the video on every measure.

How do we improve chart accuracy? Non-punitive QI culture, clear KPIs, structured checklists, and review against ground truth rather than recollection.

Sources

EMS Quality Improvement Programs — StatPearls — QA vs. QI, PDSA, KPIs, 71% dedicated-QI-personnel survey
Video Documentation as a Measure of Written Documentation Accuracy in EMS Field Intubations (HCA Healthcare Journal of Medicine, 2023) — 6% match rate and discrepancy figures
Effect of Body-Worn Cameras on EMS Documentation Accuracy: A Pilot Study (Prehospital Emergency Care, 2016) — documentation inaccuracy regardless of experience
Checklists Improve EMS Documentation (Journal of Collegiate EMS, 2020) — checklists and documentation completeness