NS Grant - Acceptance of 2008 EMS Toolkit Grant

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0 Project Narrative In the space provided, please describe your EMS System and the need for this project /funding. age County utilizes a hybrid system of paramedics in initial response, non-transport vehicles and ambulances staffed two EMTs at the BLS level. This award-winning Paramedic Initial Response Vehicle (IRV) system focuses EMS urces to provide the best possible outcomes for the patient by ensuring that every patient receives an ALS evaluation. base level of staffing in Orange County is 5 IRV paramedics and 3 BLS ambulances with an additional ambulance ;d to the system to compensate for increased load during hours of peak activity from 9:OOam to'9:OOpm. The medics are specially trained, expanded-scope practitioners who respond to all calls for EMS service. These medics ide advanced assessment and treatment as needed. Following the IRV Medic assessment, transportation may be ided by acounty-operated emergency ambulance staffed by Emergency Medical Technicians, or the patient may be red to another more appropriate form of transportation. The foundation of the IRV system is the Emergency Medical Dispatch (EMD) program, operated by telecommunicators in the County's consolidated 9-1-1 Communications Center. The system features a Phase II compliant system running EMD, AQUA and features the ability to geo-locate mobile callers. The 9-1-1 telecommunications center is generally staffed with 4 telecommunicators, all trained in EMD with an additional Communications Supervisor to handle excess call volume as well as assist in staffing, emergency incidents and other emergency situations. In addition to having the IRV paramedics and BLS ambulances, Orange County has 100 percent first responder coverage from both municipal and county fire departments. In urgent situations, these fire department first responders are dispatched with other EMS units. These First Responders have medical training and equipment and frequently arrive on scene before other EMS responders. Decreased on-scene time for the fire departments is a combination of 3 factors: there are 11 fire departments in Orange County; the fire stations are located throughout the county; all fire department calls are dispatched emergent (lights and sirens) where EMS units are given a response code based on the nature of the call. QUALITY ASSESSMENT & QUALITY IMPROVEMENT (QA/QI) Orange County's QA process begins with field supervisors reviewing all Patient Care Reports for protocol compliance. This process takes place every morning as the previous days patient care records are compiled, collated and reviewed for completeness and read for content. At this point common discrepancies are caught, documented and forwarded to either the prior shift Supervisor or the EMS Operations Supervisor. Currently all longitudinal QA/QI is driven by this daily review or by complaints received from physicians, nurses, patients or other EMS providers. Any longitudinal audit process is completed by hand, starting with someone pulling written PCRs and reviewing their content. This labor intensive process only allows review of one to two months. In addition, all audits are currently conducted by the medical director who often has to pay medical students to manually pull records from the archives which are located off-site in a locked county-owned Given the current limitations of our manual QA/QI process we feel that there is need to transit Orange County EMS to a fully automated data management system where the initial data entry is the only time data is collected and recorded. To rectify this gap, Orange County is currently in the process of purchasing an electronic data management system from ZOLL Data Systems that will allow all records to be electronically captured and submitted to the North Carolina Performance Improvement Center. In addition to full, rich compliance with the PREMIS data system, this data will enable Orange County to provide close to "real time" QA. Additionally, the data collection will also allow Orange County to review longer intervals of information to isolate ongoing gaps in care and operations that we can then bridge with .data driven solutions. Currently Orange County does not have the ability to manage the incoming data in any form that adds value to our system. E PROJECT REQUEST yen that Orange County is in the early stages of the ZOLL Data System implementation we feel that the funding from the IS Toolkit Grant could bridge a gap in our implementation team. Our project request is for personnel funding to recruit i hire a data manager to be a nine month member of the implementation team with several critical responsibilities over grant funding period. These responsibilities include: policy development, training and monitoring; ZOLL system :ntation including train-the-trainer for our growing staff; and, ongoing report generation and development of the OCEMS ,tem "dashboard". major effort of this project is to initially create the 5 policies required by the Toolkit grant. After creation, the new iplementation team member will hold small group training to demonstrate the expectations of the policy as well as how it II be measured followed by ongoing monitoring and feedback. Page 3 of 15