I was contacted recently by one of us internet EMS folks about their new role as supervisor of their dispatch center. A qualified care giver with a thirst for knowledge from the old CoEMS days, they jumped into the role with both feet and, as too many of us learn in EMS, the admin pool is a lot shallower than we had hoped.
“Hey HM, I was wondering if you had a minute for some feedback on a project. I got the comm center job this week and am shadowing the current supervisor. So far I’m learning the basics OK, but we seem to be focusing on some random stats I would be curious to hear what you think about the stats?”
They go on to list the top 3 focuses of this center:
-Code 2 dispatches that result in code 3 returns
-Call taker processing between 5 minutes and 15 minutes
-Ambulance at hospital times “Wall time”
I can’t make too much of a stink about those, except that I will. Some centers look the other way, at least we have our eyes open.
Code 2 calls in this system have a response target of 22 minutes 90% of the time. Code 3 calls, 12 minutes 90% of the time. While no one can cite WHY these random numbers are pulled out of thin air (Why does the ambulance in this area have 2 minutes longer to arrive on scene than where I live? – easy answer is the contract they signed) at first glance this is a metric you’d want to take a look at.
Why did a non-emergency call become an emergency transport?
Our friend asked what the outcome was of the dozen calls they were looking at for the month and he was met by blank stares. Apparently no one thought to find out if the emergency transport was warranted, justified or had an impact on patient condition. While new research is leaning away from code 3 transports having an impact at all, we still need to take a look.
In 8 of the 13 returns, it involved an elderly fall. The PCR’s didn’t have any time sensitive interventions, including pain control. There was no discernible reason the crews used lights and sirens to transport these non emergent falls, until he interviewed the crews. They stated feeling compassion for the patients who were found down after an extended period of time and wanted to minimize that discomfort. When asked why no interventions were performed the crews (mostly) said they were not indicated.
So here we have a dispatch center about to upgrade certain fall calls based simply on the fact that crews chose to use the lights and sirens based on their observations of discomfort, without treating them or showing benefit.
I’d argue they’re doing great but need to shift focus to a more concerning population in your data:
Code 3 calls that result in a non transport.
Why was an emergency call generated for a non-emergency situation? Is it a call taker issue? A call classification issue? Could it be similar to the reason crews are transporting certain patients lights and sirens? Sending crews out fast does not decrease system liability, it increases it.
Could it be a response metric issue? Simply sending crews out code 3 on short runs to pad the numbers? Sounds crazy but I’ve actually heard dispatchers discussing this, in multiple systems in more than 1 country.
Issue 2 – call taker processing between 5 and 15 minutes
WHAT?! Unless there is a language barrier I can’t imagine why it would take between 5 and 15 minutes to classify a call. Look into that!
Issue 3 – Ambulance wall times
Ah, yes. The hospital problem tracked by EMS. We hear often that EMS can’t truly ease ER workload simply by diverting patients, but oh hells yes we can. When we have to transport every person who wants it, we seem to stack up at the ER. Often times we are diverted to the triage desk in the waiting room with the minor injuries and chronic ailments but still have to wait for hospital staff to make space. In my system we give a radio report with an ETA but they still act surprised when 5 minutes later we arrive and there’s no bed. One hospital in NM long ago had the bed assignment board next to the EMS radio. As we made our radio report, they’d note it on the board and have a bed waiting. When we arrived we’d check the board, goto that room and begin patient transfer. After a few minutes the RN would arrive to take report. Easy Peasy. Nowadays we seem to be stuck with a triage nurse at a tiny little assessment computer more interested in the patient’s billables than their condition.
Wall times are a hospital problem. Their inefficiency slows EMS which then has an impact on response times, which then leads to non-compliance which leads to more cars on the road, you see where this is going.
So, Mr new dispatch supervisor, my advice to you is to look at everything, from all angles. Look outside EMS for concepts and solutions. Read Dan Khaneman, Dan Pink, Freakonomics, become a student of efficiency, productivity and truly strive to understand all the working parts of your system and how they interact with each other. Sometimes a simple fix far upstream can steer the river.