Michael Peters

1
NDMS Patient ReceptionArea OperationsPatient
Administration Tracking

• Michael Peters
• VA EMSHG Area Emergency Manager
• VA Central Iowa Health Care System
• Des Moines, Iowa

2
Patient Administration Tracking

• Examples from Des Moines casualty reception
  operations plans
• Excerpts from FCC Guide related to patient
  administration and tracking (Draft 29Jan04)
• Issues Questions

3
Des Moines Casualty ReceptionPatient
Administration Tracking

• Without a system standard to follow, we do what
  we think will work best in our local situations
  with available local resources.
• CY2003 Operations Plan Review
• Shift from a clinical to an administrative focus
• Move away from the MCI triage categories
• Create a new NDMS patient identification system

4
Shift to an administrative focus

• Move admin to the front of the line.
• Rationale
• With the basic planning assumption that in-coming
  patients are stabilized, the priority becomes
  tracking and accountability.
• If the patient is unstable, they bypass normal
  reception procedures.
• Increasing administrative support on the front
  end of the reception process will not adversely
  delay transport to hospitals.

5
Move away from the MCI triage categories

• Sort patients by litter vs. ambulatory status.
• Rationale
• With the basic planning assumption that in-coming
  patients are stabilized, the priority becomes
  tracking and accountability.
• If the patient is unstable, they bypass normal
  reception procedures.
• Increases visibility of litter versus ambulatory
  transportation requirements.

6
New NDMS patient ID system

• Replace METTAG with a NDMS patient tracking
  wristband.
• Rationale
• METTAG is temporary and would not stay with or on
  the patient after hospital admission.
• Patient identification wristband readily
  identifies an NDMS patient throughout their
  hospital stay.

7
Des Moines NDMS Patient ID
Patient Tracking 031107-0001
03 Year
11 Month
07 Day
Casualty received that day
8
The New Process Loading Up The Admin
Functional Exercise 11/03 Full Scale Exercise
11/04
9
Following hospital admission

• Validate hospital admission list with PRA
  tracking worksheets and transportation log.
• FCC populates local master patient tracking
  database (Excel spreadsheet)
• FCC receives daily NDMS Patient Status Report
  from each hospital.
• Diagnosis, Condition, Projected LOS, etc.
• FCC enters appropriate data into Medical Claims
  Processing System (MCPS)

10
FCC Guide (Draft 29Jan04)

• Patient Administration Excerpts
• Guidance Questions

11
FCC Guide (Draft 29Jan04)

• Chapter 1
• Definitive Medical Care
• FCCs may also coordinate lodging for displaced
  outpatients evacuated for the purpose of
  obtaining needed medical care, subject to the
  authorization and funding provided in the DHS
  mission assignment.

12
FCC Guide (Draft 29Jan04)

• Chapter 2
• NDMS Definitive Care Requirements Assessment
• Mission Assignments
• Evacuation and medical treatment for patients
  directly affected by the disaster, patients in
  the disaster area needing care no longer
  available as a result of the disaster or
  emergency, or patients not affected by the
  disaster but occupying beds that could be used
  for admission of disaster victims.

13
FCC Guide (Draft 29Jan04)

• Annex D Patient Reception Area Plans
• Patient Administration
• The FCC Coordinator assumes administrative
  responsibility for patients. This responsibility
  begins upon a patients arrival and continues
  until the patient is either returned home or, in
  the case of military patients, returned to the
  responsible Service personnel system

14
FCC Guide (Draft 29Jan04)

• Annex D Patient Reception Area Plans
• Patient Administration
• NDMS member hospitals should provide information
  to the FCC Coordinator, to include a daily
  admission and disposition list (indicating the
  expected length of stay) and a narrative summary
  upon discharge of the patient.

15
FCC Guide (Draft 29Jan04)

• Annex D Patient Reception Area Plans
• Patient Administration
• Ensure that the following information is
  included in the tracking system adopted by the
  FCC

• Patient name
• SSN
• Medical Regulating category
• Type of patient (directly injured,
  relocated/displaced)
• Home address (if available)
• Next of kin (if available)
• Admitting hospital, admission date
• Local domicile (hotel or shelter)

16
FCC Guide (Draft 29Jan04)

• Annex D Patient Reception Area Plans
• Patient Administration
• The PRA Plan should address
• Policies and procedures for disposition of
  records.
• The FCC Coordinator generally retains patient
  data for the minimum period required by statutory
  law. The FCC Director will determine, in
  conjunction with legal advice, the final
  disposition of this information. All appropriate
  patient confidentiality procedures must be
  followed.

17
FCC Guide (Draft 29Jan04)

• Annex E Patient Discharge and Return
• Responsibilities
• Patients requiring continuing health care or
  observation must be accepted by a physician at
  their home location prior to being returned.
• Patients not requiring medical care en route may
  be provided transportation procured through other
  channels. The FCC may assist representatives of
  the DOT (ESF-1) in coordinating the travel of
  returning patients.

18
FCC Guide (Draft 29Jan04)

• Annex E Patient Discharge and Return
• Returning Patients Requiring En Route Care
• Confirmation is required from a physician at the
  destination who is willing to accept and admit
  the patient
• Attending physicians at medical facilities who
  report patient movement requirements should be
  prepared to provide as much medical information
  as possible on patients as is known. Additional
  reporting requirements may be levied by GPMRC.

19
FCC Guide (Draft 29Jan04)

• Annex E Patient Discharge and Return
• Deceased Patients
• Civilian disaster victims who expire during
  evacuation or following admission to an NDMS
  hospital will be handled in accordance with
  procedures of the local medical examiner.
• FCCs may assist in burial arrangements in
  accordance with the original DHS mission
  assignment when no legal custodian is
  identifiable.

20
Closing

• Many questions remain regarding NDMS patient
  administrative issues and procedures.
• Look for additional guidance as the final FCC
  Guide is assembled.
• Thank you ?