EMS Technical Assessments for Critical

Access Hospital Communities

Mary SheridanORHP Grantee Partnership

MeetingSeptember 1, 2009

…improving access to quality healthcare for rural Idaho communities

A bit of history…

• began in 1999-2000

• 10 benchmarks (gold standards) developed through multi-stakeholder consensus-driven process

• benchmarks used to assess local EMS systems

• process similar to NHTSA system for assessing state EMS offices

Boundary

Bonner

Kootenai

Benewah Shoshone

Latah

Clearwater

Nez Perce

Idaho

Adams

Valley

Washington

Payette

Canyon

Boise

Ada

Owyhee

Twin Falls

Jerome

Lincoln

Minidoka

Cassia

Power

OneidaFranklin

Bear Lake

Bannock

Caribou

Bingham

Lemhi

CusterClark

Fremont

TetonJefferson Madison

Bonneville

Butte

Gooding

CamasElmore

Gem

Lewis

+ Certified CAH (26)

> Pending Conversion (1)

Blaine

+ Bonners Ferry

+ Kellogg

+ St. Maries

+ Orofino

+ Cottonwood

+ Grangeville

+ McCall

+ Salmon

+ Weiser

+ Emmett

+ Arco+ Driggs

+ Mountain Home

+ Gooding

+ Jerome+ Rupert

+ American Falls

+ Malad + Preston

+ Montpelier

+ Soda Springs

+ Blackfoot

Idaho Critical Access Hospitals

+ Cascade

+ Ketchum

+ Moscow

+ Burley

> Sandpoint

State Office of Rural Health and Primary CareDivision of Health, Department of Health and Welfare, 2/09

Information source: IDHW, Bureau of Facility Standards

Why conduct an assessment?

• solicit the needs and input of EMS providers located in CAH areas

• support providers and communities as they develop and implement rural health networks

• facilitate and promote system integration, communication, and training among all health and safety providers

Technical Assessment

Team of six, with varied areas of EMS expertise, travel to the community to meet with individuals previously identified and invited to speak about the EMS system.

Team members include: EMS Bureau Coordinator, Emergency Medicine Physician, CAH Administrator/Hospital Association, EMS Regional Consultant, EMS Agency Administrator, and team facilitator.

Benchmarking• compare the EMS system against 10 pre-defined optimal benchmarks- “gold standards”resource management education and trainingtransportation funding and policyfacilities communicationmedical direction system integrationquality improvement public education, information, and prevention

• more effective tool for stakeholders to use for system improvements and enhancements

• no winners and losers

Pre-site workprior to the on-site assessment

EMS agency director and hospital administrator contacted 6-8 weeks prior to the assessment

presented with program overview and information about participants to invite to the assessment; location set

sent informational packet with program overview, suggestions for invitees, benchmarks

additional agencies sent information

invited participants sent informational letter about the project and assessment day expectations

Assessment Process

informal discussion in group, round table setting

participants scheduled for 15-30 minute intervals; encouraged to stay

team members responsible for their assigned benchmarks

team allows each participant to speak about the EMS system from their perspective and asks questions for clarification

Assessment process

Team members discuss each component area and draft document:

• assess status relative to benchmark

• recommendations to move from current status toward benchmark

• reaching consensus (and the value of a great facilitator!)

Follow-up:

• assessment to stakeholders and follow-up meeting

Resource Management

StandardAgency coordination and current knowledge of system Agency coordination and current knowledge of system resources is essential to maintain a coordinated response and resources is essential to maintain a coordinated response and appropriate resource utilization within an effective EMS appropriate resource utilization within an effective EMS system…system…

StatusClearwater County Ambulance submits patient care reports for all responses. The agency receives quarterly and annual aggregate data reports from state EMS…

Recommendations• Develop and implement a formal recruitment and retention program;• Conduct a countywide equipment inventory to track resources.

We know it’s fun, but so what…?!

• participant input regarding system status and needs

• provide opportunities for collaboration and cooperation

• group decision regarding grant fund

• community assessments by “experts”, casual setting

• no obligation: resulting document as tool or trash

Benefits

Encouraging results...• assessment team well-received

• meetings provide opportunities for collaboration among various stakeholders

• enthusiastic leaders

• dedicated volunteers, although most work long hours with little or no compensation

• medical directors volunteer many hours to support EMS agency efforts

• receptive to recommendations: most implemented or in-progress

You think we’re only famous for

potatoes, but we’re also home to the only man-made geyser in

the world.

Thank you!