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Ambulances Under Scrutiny

DENVER -- Denver Health on Thursday released a study that argued the hospital's emergency medical system's performance should be judged on more than just ambulance response time - an issue that's become controversial in recent months.

The 60-page report, conducted by a research firm hired by the hospital, comes as the city auditor nears completion of a review of whether the hospital is meeting the terms of its city contract. That pact says a Denver Health ambulance must reach a patient within 8 minutes, 59 seconds for 85 percent of 911 calls.

Denver Health maintains that it is in compliance with the contract, but the report said other measures of patient survival outcome should also be taken into account to assess performance.

"Nationally, the better EMS systems do not rely solely on direct indicators - such as response times - to assess how patients fare under their systems; they track patient outcomes directly," according to the report compiled by Denver-based Health Policy Solutions.

Denver Health's emergency system has one of the nation's best survival rates at 28 percent for shockable arrhythmias, a commonly used cardiac arrest measure, according to the report. By comparison, the national average is 6 percent to 10 percent. The hospital's trauma survival rate is the best in the nation, the American College of Surgeons reported this month.

Report 'not competing'

Denver Health released the $20,000 report to city officials, the auditor, fire department and City Council members. The hospital intends for the study to be "complementary and not competing" with the city auditor's impending report, said Dr. Patricia Gabow, the hospital's CEO and medical director.

Denis Berckefeldt, spokesman for Denver City Auditor Dennis Gallagher, said he is legally barred from saying whether Denver Health is in compliance until the audit becomes public.

Still, he hinted at what the audit has found. "There's been enough information coming out that the response times . . . are not probably consistent with what they should be in the contract," Berckefeldt said.

One of the key issues the contract does not make clear, Berckefeldt said, is how to measure response time. The hospital begins timing when an ambulance begins driving toward the scene, while council members Michael Hancock and Doug Linkhart say the clock needs to start when the 911 call is answered.

There can be a lag while a dispatcher looks for an available ambulance to respond to a call.

The Denver Health study, conducted by Tracy Johnson, Ph.D., through interviews with hospital and fire department officials as well as national emergency medical services experts, sought to understand Denver Health's operations as well as how it compares with peers.

"As an academic institution and as an institution that has a long history of quality commitment, we want to always try to understand how we can be better," Gabow said.

Coverage is a concern

Critics charged that the report selectively used statistics and avoided talking to detractors. Bob Petre, president of the International Association of Firefighters Local 3634, which represents paramedics, and a paramedic for 24 years, said the study's author doesn't have a background in emergency medical systems. Johnson holds a doctorate in public health from Johns Hopkins University and recently served as a technical adviser to the Colorado Blue Ribbon Commission for Healthcare Reform.

Petre said Denver Health needs to add "more transparency and accountability" to its emergency response operations as well as 10 more ambulances to its fleet.

Hancock said he received the study but hadn't read it yet.

"I'll see if I can glean from this any recommendations on standards," he said. "If not, we still have work to do."

Hancock said response times are only part of what needs to be addressed. He's also concerned about adequate coverage, especially in his large district in northeast Denver. "We need to make sure that the EMS services have grown or expanded with the growth of the city," he said.

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