NH INTERFACILITY TRANSPORT SUMMIT 2006

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NH INTERFACILITY TRANSPORT SUMMIT 2006
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WELCOME

• Suzanne Prentiss
• Bureau Chief
• NH Div. of Fire Training EMS

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SPONSORING AGENCIES

• NH DEPARTMENT OF SAFETY, DIVISION OF FIRE
  STANDARDS AND TRAINING AND EMERGENCY MEDICAL
  SERVICES
• NH DEPARTMENT OF HEALTH HUMAN SERVICES,
  DIVISION OF PUBLIC HEALTH SERVICES, BUREAU OF
  COMMUNITY HEALTH SERVICES, RURAL HEALTH PRIMARY
  CARE SECTION

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INTRODUCTION

• Clay Odell

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INTRODUCTION

• 2004 FEEDBACK FROM HOSPITALS GROWING PROBLEM
  WITH INTERFACILITY TRANSPORT OF CRITICAL PATIENTS
• 2004 NOVEMBER - NH TRAUMA SYSTEM CONFERENCE
  FOCUS ON INTERFACILITY TRANSPORT
• 2005 MARCH - INTERFACILITY TRANSPORT SUMMIT

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INTRODUCTION

• 2005 MAY - INTERFACILITY TRANSPORT TASK FORCE
  BEGINS MONTHLY MEETINGS
• 2006 MARCH - INTERFACILITY TRANSPORT SUMMIT II

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NH IFT TF

• MISSION STATEMENT
• The Interfacility Transport Task Force will work
  to improve the efficiency of interfacility
  ambulance transfers without sacrificing quality.
• Efficiency reduction of time to secure an
  ambulance resource to do the transfer and
  decrease in the workload of the person calling to
  request an ambulance.
• Quality An ambulance resource that is safe and
  has the correct level of care.

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NH IFT TF

• WORKPLAN
• REVIEW RESULTS OF 2005 INTERFACILITY TRANSPORT
  SUMMIT
• SET PRIORITIES

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WORKPLAN

• ELIMINATE DECISION MAKING BASED ON ABILITY TO PAY
• INVESTIGATE SHARING OF CREW RESOURCES
• DRAFT A GENERIC DECISION TREE TO MATCH PATIENTS
  NEEDS TO RESOURCES
• STUDY COSTS OF INTERFACILITY TRANSFER
• IMPROVE COORDINATION OF RESOURCES

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OBJECTIVE

• CONVEY TO THE HOSPITAL AND EMS COMMUNITY THE
  SOLUTIONS THE IFTTF PROPOSED
• INITIATE DISCUSSIONS AT THE LOCAL LEFT TO
  IMPLEMENT THOSE SOLUTIONS

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Improving Inter-agency Cooperation

• Clay Odell

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IMPROVE INTER-AGENCYCOOPERATION

• PERCEPTION THAT SOME EMS AGENCIES ARE ACCEPTING
  PATIENTS THAT ARE LIKELY TO BE REIMBURSED AND
  REFUSING UNINSURED
• IF AN OUTSIDE SERVICE IS CALLED THE ASSUMPTION
  WAS WERE ONLY CALLED WHEN SO SO TURNS THE
  REQUEST DOWN, AND EXPERIENCE SHOWS WE ONLY GET
  THE UNINSURED

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IMPROVE INTER-AGENCYCOOPERATION

• GOAL - ELIMINATE DECISION MAKING BASED ON
  ABILITY TO PAY
• FOR EMERGENT TRANSPORT ONLY
• QUITE A BIT OF TIME SPENT ON HOW TO BEST APPROACH
  
• FINALLY HAD A FACE TO FACE DISCUSSION WITH
  CERTAIN PARTIES

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IMPROVE INTER-AGENCYCOOPERATION

• RESULT - MANAGEMENT AT SAID SERVICE EXPRESSED
  BUSINESS PRACTICE CONSISTENT WITH OUR GOAL
• ALL SERVICES APPEAR TO HAVE BUSINESS PRACTICE OF
  ACCEPTING EMERGENT TRANSFERS BASED ON
  NON-FINANCIAL REASONS

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IMPROVE INTER-AGENCYCOOPERATION

• TASK FORCE RECOMMENDS HOSPITAL REQUESTS FOR
  EMERGENT TRANSFERS DONT PROVIDE FINANCIAL
  INFORMATION UNTIL THE PATIENT IS ACCEPTED BY AN
  AMBULANCE SERVICE

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IMPROVE INTER-AGENCYCOOPERATION

• QUESTIONS - COMMENTS

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An Improved Method of Determining Ambulance
Resources Needed

• Chandra Engelbert

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NH Hospitals
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Terms/Definitions

• Emergent/Urgent
• Essential
• Routine

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Transfer Setup Process
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Ambulance Services

• Service
• Distance
• Travel Time
• Phone
• Alternate Methods of Transport

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Air Ambulance

• DHART (35 Min) 1-800-650-3222
• Life Flight of Maine (70 Min)1-888-421-4228
• Boston MedFLight (70 Min) 1-800-233-8998
• UMASS Med Flgt (69 Min) 1-800-343-4354
• Albany Med Flight 1-800-525-6333

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Transfer Level Decision Process
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Additional Information

• Paramedic Medication List
• EMT-B Skills
• EMT-I Skills
• EMT-P Skills
• CCEMT-P Paramedic

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Conclusion

• Discussion
• Questions

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EMS Crew Resource Sharing

• Administrative Issues for Transfer Personnel
• Dave Dubey Jeanne Erickson

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(No Transcript)
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Topics

• Certification/Licensure
• Reimbursement
• Insurance Coverage
• Employee Health
• Orientation
• Uniforms

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Certification/Licensure

• Verify Certification and licensure
• Add Provider Affiliation
• Narcotics Licensure

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Reimbursement
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Reimbursement

• Hourly vs. per-Transfer rates
• Travel Time
• Travel Pay

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Insurance Coverage
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Insurance Coverage

• Workers Compensation
• Malpractice/Professional Liability
• Vehicle Insurance
• (Drivers license for MV record Check)

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Employee Health

• Other Screening Procedures as Needed

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Employee Health

• Immunization Update
• Other Screening Procedures
• (as needed)

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Orientation

• Introduce Staff and Medical Director

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Orientation

• Familiarize with Vehicles and equipment

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Orientation

• Review Applicable Policies/Procedures
• Introduce Staff and Medical Director
• Familiarize with Vehicles and Equipment
• Med Boxes, Cardiac monitor, IV pumps etc.
• Driver Training
• Radio operation
• Receiving Facility procedures
• En Route Emergency Diversion Procedures

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Uniforms
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Data Collection Tool

• Why? And How?

Alisa Butler, Rural Hospital Flexibility Program
Manager NH DHHS Rural Health Primary Care
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Define the Problem

• Is there a transfer problem?
• What is the nature of the problem?
• Who is experiencing the problem?
• Targeting solutions

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Creating the Data Collection Tool

• Several different versions
• Numerous data points (interesting but not
  relevant)
• Go over example
• Questions?

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Using the Data Collection Tool

• Person who normally makes the call to request a
  transfer.
• May integrate into existing forms as long as
  required data is still collected.
• Data may be reported electronically or by sending
  in paper copy.
• Deploy for a limited time period (3 months).

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Then What?

• Analyze data, possibly revise form and then
  re-deploy for another limited time period.
• Look for local or regional trends.
• Examine whether current priority items address
  problems identified in the data.
• Look for opportunities to collaborate on
  solutions.

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Conclusion

• Questions? Comments? Concerns?

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Update on the Interfacility Transport Exception
Program

• Clay Odell

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WHAT IS IT?

• A change in the NH EMS Statute enabling
• A Critical Access Hospital
• With a need to transfer an emergent patient
• That is unable to get an ambulance with a full
  crew, may...

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• Send a specially trained nurse, PA or physician
  as the second crew member of the ambulance
• This is called the Interfacility Transport
  Exception (IFTE) program

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To be eligible

• Provider must be a CEN, emergency PA or emergency
  physician
• Must attend a NHBEMS approved IFTE Transition
  Program
• NHBEMS conducted a IFTE training program in
  Lancaster in October 2005
• NHBEMS conducted a train the trainer program in
  March 2006 and has a list of approved instructors

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• Currently a bill before the NH Legislature
  (SB-260) adding Certified Critical Care
  Registered Nurses (CCRN) to the list of providers
  eligible to participate as IFTEP providers
• SB-260 currently in the NH House of
  Representatives, Executive Departments and
  Administration Committee, hearing on March 28

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• Questions
• Comments

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Use of RCHIP Grants For Interfacility Transfer
Projects
Alisa Butler, Rural Hospital Flexibility Program
Manager NH DHHS Rural Health Primary Care
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RCHIP

• Rural Collaborative for Health Improvement
  Projects (RCHIP)
• Rural Hospital Flexibility Program federal grant
  dollars disbursed through the Foundation for
  Healthy Communities to Critical Access Hospitals
  (CAH)

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RCHIP Continued

• CAH were asked to submit mini-grant proposals
  to work in cooperation with a local EMS unit, EMS
  regional council and or local government to
  strengthen the coordination and quality of EMS
  locally through
• Strategic needs analysis
• Team building and/or strategic planning
• Systems development activities or
• Quality improvement initiatives.

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IFT Workgroup Efforts

• Identify short term opportunities
• Letter to North Country CAH Administrators

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IFT Projects

• Awarded 13,000 for each grant project
• AVH- Consolidate EMS education programs and use
  capital to create EMT-FR, EMT-B and EMT-I
  programs and support systems to sustain EMS
  educational programs into the future.
• Cottage Funding training for local providers
  for paramedic training (2-5 candidates), EMS
  training (up to 10 candidates) and continuing
  education of existing squad members.
• Littleton Continue to plan, coordinate and
  develop a comprehensive area critical care level
  transport program in collaboration with Cottage
  Hospital, Weeks Medical Center and others in the
  North Country. Also will provide training for
  nurses to acquire critical care emergency
  transport certification under Senate Bill 88.

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IFT Projects continued

• Speare Funding a critical care transport
  program by hosting an accredited critical care
  transport course and sponsoring a minimum of four
  area Paramedics to participate and providing the
  necessary equipment and quarterly critical skills
  enhancement programs.
• Weeks Collaborate with area hospitals and EMS
  providers to plan and provide PEPPS (pediatric)
  and PHTLS (trauma) courses. Work with an area
  hospital providing a critical care for paramedics
  course and sponsor two local paramedics to attend.

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Conclusion

• New projects (training pool and mentoring)
• Questions?