Okaloosa County BOCC — April 7, 2015 — NaCO Award CTP 2015 — reading text

This program rises to that reality by maximizing the resources available and leveraging the good relationships with multiple organizations committed to a common goal. EMS and Fire Department Training Officers were given the responsibilities of performance measurement, data analysis, and training program development. Department Chiefs and the Medical Directors collaborated; training schedules were approved so training could occur during regular duty hours and overtime budgets wouldn’t have to be expanded for off duty training. All agencies involved in Page |4 the program shared their facilities so training could be rotated around to ensure all responders got what they needed. The full capabilities of the existing data collection system were exploited so no new investments in data capture systems would be required. No new technology was required and only a few pieces of training equipment that did not strain the budget needed to be purchased. Overall, the program leveraged its existing talent and resources within the framework of cooperative relationships to make this program the success it is today. USE OF TECHNOLOGY The success of this program is owed in large part to the fact that it does not rely exclusively on technology. The previous training system made exclusive use of a commercially available web-based programs. As such, employee training was subject to the prevailing internet speed, network constraints, and their own motivation to sit behind a computer to train. The most technologically complex system used in this program is a web-based data system from which all CCMs are collected from the patient care records submitted and analyzed. Beyond that, email is used to schedule meetings and share information between committee members and audio/visual software and equipment is used to present training materials to the medical staff. If either one of these systems fail, redundancies are in place to facilitate uninterrupted conduct of the program. Other elements of the training program rely on life-like mannequins and operational medical equipment for a realistic as possible training experience in the laboratory. THE COST OF THE PROGRAM The cost of the program is negligible compared to the costs of the consequences of the previous training system. Between 2012 and 2014, there were 18 general liability claims against Okaloosa EMS amounting to $86,851 in total costs incurred. Also in the same period, 77 workers comp claims were filed for work related injuries amounting to $483,323 in total costs paid. Since 2014, there have been no new general liability claims for medical errors and workers comp claims are trending downward due to the training which also addresses issues related to employee safety in the field. All of the capital, with the exception of a few training mannequins and reference materials, was already in place. There was no need to purchase anything related to computing or A/V technology because it already existed where it was needed. The most substantial cost of the program was in the man hours needed to conduct it. However, because the vast majority of the review, analysis, and training occur during on-duty hours, these costs would be incurred regardless. Regular Staffing Hours - $15,300 Overtime Hours (primarily for instructors) - $ 5,000 Page |5  Training Materials - $ 3,000 Travel Expenses - $ 500 Total Outlay in FY 14 $ 23,800 The data management system used to collect and analyze patient care data is part of an already established contract for EMS billing and medical record management software so no additional costs for data management were realized. Most importantly and as previously pointed out, the cost of not developing and implementing this plan would have been far more expensive to patients of Okaloosa County EMS and ultimately the taxpayers of Okaloosa County. THE RESULTS/SUCCESS OF THE PROGRAM As discussed in a previous section, the organization’s clinical competency baseline in early 2014 confirmed the anecdotal assumption that, as a whole, patient care was at and in some categories below standard. However, real and objective data emerged over the course of the year that strongly indicated quality was improving. For example: Advanced airway management in the pre-hospital setting is a critical skill that if poorly performed can have a lasting and negative effect on the patient, if he even survives. A program performance measure for Airway Management was created and required a successful management of the patient’s airway on the first attempt at endotracheal intubation 95% of the time and on the second attempt 100% of the time. Early data indicated that the system-wide average was slightly over 90% - well below the established measure for clinical competency. An advanced airway training module based on the existing airway management protocol and this new data focused on improving the provider’s understanding of airway management as well as the practical application of the concepts in the field. In the second quarter of 2014 the system-wide average for advanced airway management had improved to 94.4% and by the end of the third quarter it had increased to 98%. By defining, measuring, analyzing, and training, the program successfully increased system-wide competency in this critical area of care and greatly improved quality within a period of six months. In another example, the ability to make advanced hospital notification to the receiving hospital via radio or telephone in cases where patients were identified in the field as experiencing Acute Coronary Syndrome (ACS) was measured. To identify ACS the provider must perform a 12-lead EKG in the field and then properly interpret the study. The competency target for this performance measure was set at 90% for the correct interpretation of the EKG and resulting in advanced notification to the appropriate receiving hospital. Baseline competency was measured at 94% in the first quarter of 2014. By the end of the fourth quarter 2014 competency was measured at 98% system-wide. Page |6  As a third example of performance measurement processes, focus was placed on report writing practices as they related to completeness, timely submission, and billability. Fourth quarter 2013 data analysis showed that 23% (77% competency) of all reports submitted were either late, incomplete, or failed in some way to support the collection of transport fees by the billing company. In November 2013, the EMS billing contractor estimated potential revenue loss of $600 thousand due to incomplete or delayed reporting in 2014. As in the previous examples, a performance measurement and training processes for reporting was implemented and target competency was set at 90%. Incomplete and delayed reporting decreased dramatically throughout 2014 and the latest measurement as of this writing is 97%. WORTHINESS OF AWARD The Okaloosa County EMS Comprehensive Quality Assurance and Training Program satisfies all of the program criteria outlined in the 2015 NaCO Achievement Award brochure: This program has significantly improved the administration of the EMS Quality Assurance plan and has fostered the development of a culture of accountability and competence in pre-hospital medical care in Okaloosa County. The level of training and professional development offered to paramedics and EMTs operating in the field is also greatly improved. The program outcomes demonstrate levels of pre- hospital medical care that meet and surpass the minimum standards of care set by state and federal laws and codes. As described in the previous section, the results of this program are indeed measurable and the latest data shows remarkable improvements in performance over the 2014 baseline. As well, intergovernmental cooperation has increased due to the engagement of the ALS Fire Departments and local hospitals in the program. This program relies on innovative and cooperative relationships between area hospitals, fire departments, and County EMS. Where most politically separated agencies consider the minute aspects of internal performance data proprietary, all data related to quality of care in Okaloosa County is shared. Very few systems if any share performance data on the level it is shared in this program. Due to the relationships and agreements in place, all responders in Okaloosa County, regardless of jurisdictional boundaries or political division, share in a common effort to enhance pre-hospital care. Finally, all elements of the program are consistent with acceptable governmental and financial management practices and accountability in pre-hospital medical quality and training for providers is measurably higher. Page |7