Editor’s Note: JEMS Editor-in-Chief A.J. Heightman, MPA, EMT-P reports from the American Ambulance Association (AAA) Annual Conference being held this week at Caesar’s Palace in Las Vegas.
In “Best Practices in EMS - Beyond the Basics,” JEMS Editorial Board member and North Shore - LIJ Center for Emergency Medical Services (N.Y.) Assistant Vice President Jonathan D. Washko, BS-EMSA, NREMT-P, AEMD, defined a “best practice” in EMS as, "A belief that there is a technique, method, process, activity, incentive or reward that is more effective and efficient at delivering a particular outcome than any other technique, method, process, etc."
He told American Ambulance Association (AAA) Annual Conference attendees that EMS needs best practices because we have no universal standards or a standardized advanced managerial education platform
He presented two poignant quotes from famous EMS economist and visionary Jack Stout:
"Economic efficiency is nothing more than the ability to convert dollars into service."
"It's impossible to waste dollars without wasting patient lives."
Washko said it’s important for EMS to focus on the following key areas:
• Clinical sophistication;
• Customer service; and
• Systems integration.
• Compensation and benefits; and
• Health, safety and welfare
He discussed the importance of the 2011/2012 National EMS Advisory Council (NEMSAC) finance subcommittee report, “EMS System Performance-based Funding and Reimbursement Model.” To create this report, subcommittee members looked at the future of EMS funding and came up with 11 conclusions and two recommendations. Go to http://www.ems.gov/nemsac/FinanceCommitteeAdvisoryPerformance-BasedReimbursement-May2012.pdf to review them.
The subcommittee also took a close look at what we really do in EMS: Their results were as follows:
Healthcare is 53% of EMS’s mission;
Public health is 14% of EMS’s mission;
Public safety is 21% of EMS’s mission; and finally
Emergency/disaster preparedness is 13% of EMS’s mission.
Cut Like a Knife
North Shore LIJ (N.Y.) Hospital System Assistant Director of Operations Paul Power, CCEMT-P, spoke about logistics and safety best practices. He and Washko said their facility adopted a "Swiss Army knife concept,” in which as many vehicles as possible can do as many things as possible.
Examples of this include:
1. A fully deployable crew safety net webbing system that can be easily be put in place in the patient compartment to physically separate a psychiatric patient from the attendant in the patient compartment while still allowing care and observation. (Their system transports more than 2,000 non-emergency psychiatric patients in their units per year and their crews use the "Power Net" several times each day.)
2. Placement of a simple aisle step that is mounted on the floor of the ambulance, next to the bench seat. This ensures the primary stretcher doesn’t drift too far to the right and result in a stretcher drop if it doesn’t catch the stretcher hook at the rear of the patient compartment floor.
3. A redesign of the rear bench seats to allow the "head" end to be elevated like a beach chair and facilitate the transfer of multiple patients—as they did during Hurricane and Irene and Sandy recently.
4. Reconfiguration of ambulances to allow them to use compressed natural gas (CNG). They anticipate 300 miles per 40 gallons of CNG, at 50% of the cost of regular fuel.
5. Implementation of mobile supply vehicles to meet and restock vehicles in the field—at their staging/posting locations and of a mobile washing unit to keep their vehicles clean and sanitary.
Best practices that have emerged over the past year include benchmarking and quantification of quality. Many healthcare systems are now using the Institute for Healthcare Improvement (IHI) model for process improvement and Washko urged all EMS systems to read up on and follow the IHI model. He said we should look carefully at and benchmark satisfaction of patients, employees and stakeholders because this helps drive quality, efficiency, effectiveness and customer loyalty but more importantly is how healthcare measures and benchmarks itself.
Washko pointed out that claims data will become more important in the future. This will help you see trends that provide savings opportunities for payers—both in the field and downstream. He suggested that EMS agencies go to the private payers with ideas before they come to them. Learn how to partner with them.
Washko said there acquisitions of ambulance services, including by hospitals, is increasing and that full system integration includes the following healthcare industries and roles.
• Primary care: Community and expanded-scope paramedicine;
• Prehospital: Triage to appropriate locus of care (i.e., the programmable scalable information assurance model or PSIAM);
• Acute/Hospital: Transport to the most appropriate facilities.;
• Post acute: Off hours primary care physician or home health supplementation (urban) or direct service provision (rural); and
• Physician Extender Roles (a throwback to the Johnny and Roy days) for in-home clinical decision support.
Washko reported on some of most innovative products and manufacturers in the industry. These included the following
Ferno Inc.’s 2020 Vision, which includes the following components:
• Customizable and configurable ambulance interiors;
• A self-loading, independent stretcher that doesn’t require a big floor assembly and mounting device;
• A motorized stair chair;
• An advanced integrated electronics supplementation system called ACETECH;
• A cloud-based complete data system, including an advanced customizable clinical and operational decision-support system (SmartPath) and customizable form questionnaires (SmartForm)
• An integrated electronic master patient index and electronic medical record
• An integrated computer aided dispatch (CAD) system including AVL through the use of cell phone and tablet GPS functionality
• Integrated advanced built VOIP based telephony including conference calling, call transfer and integrated call recording where the voice recording associated with the call are directly integrated and available within the patient care record.
• Advanced directory of services that is integrated into workflows for easy patient navigation to the closest, most appropriate facility.
• Provider scheduling and shared calendar booking and appointment creation
• And many more advanced features.
Twisted Pair, which allows you to integrate legacy LRM radio systems and couple them with new 4G networks and a smart phone application that allows advanced trunking radio functionality over a cell phone
Life EMS and AEV Inc., announced an unveiling of Life EMS’s second generation safety concept vehicle that incorporates the latest in crew safety with a unique patient centered interior design.
EMS needs best practices to turn to in order to short circuit the amount of time for service self-improvement. Additionally, EMS needs to align with its primary mission, healthcare, including the use of IHI-based approaches, measuring, benchmarking and transparent sharing of outcomes and satisfaction scores.
Lastly, EMS needs to leverage technology that integrates data, makes your service more effective, efficient, reliable and safe.