Posted by: medicblog999 | November 2, 2009

A new development in my Service

CB108139I just found out today, that a new service initiative goes live tomorrow in my main A&E department in my area.

I’m not sure if this is a revolutionary thing, but I haven’t heard of any other service doing this yet, so I was wondering what you all think of it?

I have read various blogs in the past talking about ‘ramping’, i.e. Ambulances stacking up outside of an ER, unable to off load their patients due to the department being too busy to take a handover and take over care of their patients. There is also the continuous issue of hospital turnaround times for crews, which in the case of ‘ramping’ having busy departments is not always the fault of the crew.

With the upcoming second wave of Pandemic swine flu about to hit, my service has tried a slightly different approach to try and reduce the impact that an overflowing A&E department may have on the provision of continued pre-hospital care. How can we respond to emergencies if we cannot get clear from the A&E department?

One of the solutions is a computer system that has been installed in the Accident and Emergency department and which goes live tomorrow. The purpose of the system is that when I am in my ambulance or rapid response car, and I press the ‘leave scene’ button on my computer screen and select which hospital I am going to, the information will automatically be passed to a computer screen in the department. They will get my call sign, patient details, patient condition, any updates I provide via control and an estimated ETA.

This should help them to look at the current patients in the department and move some around, if required, to accommodate any patients that the ambulance service may be bringing in. It will hopefully help them plan ahead like they have never been able to before.

With one click of a mouse, the staff will be able to see for example, that 6 ambulances are currently en route to them, with ETAs of 4 mins, 2 x 9 minutes, 15 minutes, 25 minutes and 40 minutes. They will be able to pre-empt how many resus beds, rooms or cubicles they will need to have available and in essence they will be able to triage the patient before we even arrive.

This is the initial step, which will be further enhanced when we eventually move over to the electronic PRF which we will be able to transmit to the A&E department before we even arrive.

As well as assisting the hospital for bed allocation and management, it will also be used to keep an eye on hospital turnaround times and will hopefully encourage crews to become available as soon as possible once the patient has been handed over. The benefit here though is that the nursing staff will actually hit a button to record the time when the patient has been handed over, but only once the patient is on the hospital trolley and the crews stretcher is out of the room, unlike when it is currently recorded at the moment, when the nurse takes the verbal handover from the crew.

It should be interesting to see how it all develops. Personally, I think it is a great idea and if used correctly, could go a long way to help the worse than usual ‘winter pressures’ that we see at this time of year.

What do you think?

Does your service has something similar, and if so, has it been useful?

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Responses

  1. I like this idea. The system we use in our department is a little different. We basically get in touch with dispatch once we make patient contact and ask if their choice of hospital is green or red. Red meaning they are on divert because they are too busy, in which case we transport to the next closest appropriate facility. Once we arrive at the hospital we are shown to the room that they have waiting for us and we do our report, transfer the patient and clean our gurney and get ready for the next call (or post). We have 20 minutes from the time we arrive at the hospital until the time we have to be ready for our next call. Sometimes when we have low levels we may be “bounced” at 10 minutes. If we cannot clear (due to extended cleanup or difficulty with transfer of care) we let dispatch know and they just have to wait…no matter what level we are at. Your new system would basically stop certain crews from being able to skive by saying they are extended when in fact they are just enjoying a cuppa. Our system is based on honesty and I can safely say that there are only a few crews who do not “work the system.” I actually like running the calls and enjoy working with someone who shares my need. I have been stuck with medics who like to milk the 20 minutes, which usually means I am sitting in the ambulance reading EMS blogs about who is better, US or UK :)I think your system keeps people honest since it is the nurse who lets dispatch know when transfer of care happened. It would be a rude awakening for some crews over here. Just one question though. What happens when this new system goes belly up? What is the backup plan? Do you guys still do a radio report on the way in to the hospital even if they have this fancy new system? What about patient privacy risks if someone “hacks” the system?

  2. We have it … its called REPAC (I can't remember its whole official name) and its our headache, but they tell us it works and its a keepers. Basically this is how is work – we have an interactive computer system that looks at each hospitals/Urgent Care Centre separately. The computer system tells dispatch based a crazy amount of information (total patients, CTAS levels (Canadian Emergency Department Triage and Acuity Scale), total beds avail, what type of ER assessments required ect ect ect) and its tells dispatch which hospital would be the best to transport to, in hopes that the medic is not tied up for hours and hours in the hospital waiting for a bed. It work, kind of, the only times REPAC is basically wrong is when the Medics override it with the excuse of 'PT refused REPAC recommenation' and when Dispatch forgets to put in a transport. REPAC tells the hospital the ETA of a medic unit, and some limited information like if the pt is a destination pt, or a medivac pt. REPAC has 4 colour status for each of the hospitals, and the status of the EMS (green, yellow, orange, and red). The rules are based on the colour statues of EMS and the hospitals, a basic way of thinking is when the hospitals are red the medics shouldn't transport to them, and then when EMS is in a orange/red alert (orange is < 8 transport trucks and red is 0 transport trucks) EMS can transport to the top two priority hospitals no more what their status is.Its a love hate relationship. Our medics are still waiting close to 1 hr + in the hospital before the much wanted bed, but was better then it was before. There are times when the ambulance bays at the hospital are bursting at the seams, with city and rural medics sitting in the queue waiting with their patient to get a bed or move to the waiting room. Days like that happen still happen, but they are very few and frequent. If you want more information, just email me and I will try to enlighten you.

  3. this system has been trialled in the capital cityUK and works in conjunction with the electronic PRF's that will soon roll out. Good idea, but not so good as in you cant have a cuppa at hospital without being 'watched'

  4. we have it in the east of england we also have cams where the hospitals report bed states to ourselves this appears on the box in the truck when we are en-route to the job informing of any hospital delays.whilst it sounds good with the distances involved between hospitals here in east anglia the patients always express a wish to attend the nearest one.the system telling the hospital what to expect works well if they are able to have time to consult it. The info on the clinical nature of the call is based on the amps triage eg chest pain, cva , collapse etc this as we know is not always what we find on arrival at the patient so the hopital may be told a fall cat c patient has been assesed and due to arrive whilst the patient may be a periarrest patient who collapsed not fell. so serious patients still need a clinical prealertthe hospital is supposed to click on the screen on patient transfer to trolley thus recording handover time we are then supposed to clean the trolley etc and be available within 15 mins of this. the screen for the recording of this is at the nurses station not in the various trolley bays so hospital staff (especially when they are busy) press the button on initial verbal handover before so control call us after 15mins asking if we are available whilst the patient is still on the trolley waiting for a bed.EPCR real time reporting sounds great but in practice we have all reverted to paper forms the hospitals never had time to read them and they never got printed off so the prehospital observations never got used. The hospitals could not access them until we had completed them which was not until the patient form was signed (using pen on screen) i like the idea of the epcr but the version we use is cumbersome with many menus if designed like our paper forms would be wonderfull but instead they added so many new audited fields it took so long to fill in control would be calling use after handover asking us to green up whist we were still filling it inwhen there is a choice of hospitals to take patients to these reporting features can be useful to road crews and i am sure hospital management could find it useful if capacity existed in the hospital to move patients. our problems in the past year has been only one regional hospital which is running at full capacity so if no beds no spaces in A & Eat least a & e cannot act surprised when you turn up with a patient

  5. we have it in the east of england we also have cams where the hospitals report bed states to ourselves this appears on the box in the truck when we are en-route to the job informing of any hospital delays.whilst it sounds good with the distances involved between hospitals here in east anglia the patients always express a wish to attend the nearest one.the system telling the hospital what to expect works well if they are able to have time to consult it. The info on the clinical nature of the call is based on the amps triage eg chest pain, cva , collapse etc this as we know is not always what we find on arrival at the patient so the hopital may be told a fall cat c patient has been assesed and due to arrive whilst the patient may be a periarrest patient who collapsed not fell. so serious patients still need a clinical prealertthe hospital is supposed to click on the screen on patient transfer to trolley thus recording handover time we are then supposed to clean the trolley etc and be available within 15 mins of this. the screen for the recording of this is at the nurses station not in the various trolley bays so hospital staff (especially when they are busy) press the button on initial verbal handover before so control call us after 15mins asking if we are available whilst the patient is still on the trolley waiting for a bed.EPCR real time reporting sounds great but in practice we have all reverted to paper forms the hospitals never had time to read them and they never got printed off so the prehospital observations never got used. The hospitals could not access them until we had completed them which was not until the patient form was signed (using pen on screen) i like the idea of the epcr but the version we use is cumbersome with many menus if designed like our paper forms would be wonderfull but instead they added so many new audited fields it took so long to fill in control would be calling use after handover asking us to green up whist we were still filling it inwhen there is a choice of hospitals to take patients to these reporting features can be useful to road crews and i am sure hospital management could find it useful if capacity existed in the hospital to move patients. our problems in the past year has been only one regional hospital which is running at full capacity so if no beds no spaces in A & Eat least a & e cannot act surprised when you turn up with a patient

  6. we have it in the east of england we also have cams where the hospitals report bed states to ourselves this appears on the box in the truck when we are en-route to the job informing of any hospital delays.whilst it sounds good with the distances involved between hospitals here in east anglia the patients always express a wish to attend the nearest one.the system telling the hospital what to expect works well if they are able to have time to consult it. The info on the clinical nature of the call is based on the amps triage eg chest pain, cva , collapse etc this as we know is not always what we find on arrival at the patient so the hopital may be told a fall cat c patient has been assesed and due to arrive whilst the patient may be a periarrest patient who collapsed not fell. so serious patients still need a clinical prealertthe hospital is supposed to click on the screen on patient transfer to trolley thus recording handover time we are then supposed to clean the trolley etc and be available within 15 mins of this. the screen for the recording of this is at the nurses station not in the various trolley bays so hospital staff (especially when they are busy) press the button on initial verbal handover before so control call us after 15mins asking if we are available whilst the patient is still on the trolley waiting for a bed.EPCR real time reporting sounds great but in practice we have all reverted to paper forms the hospitals never had time to read them and they never got printed off so the prehospital observations never got used. The hospitals could not access them until we had completed them which was not until the patient form was signed (using pen on screen) i like the idea of the epcr but the version we use is cumbersome with many menus if designed like our paper forms would be wonderfull but instead they added so many new audited fields it took so long to fill in control would be calling use after handover asking us to green up whist we were still filling it inwhen there is a choice of hospitals to take patients to these reporting features can be useful to road crews and i am sure hospital management could find it useful if capacity existed in the hospital to move patients. our problems in the past year has been only one regional hospital which is running at full capacity so if no beds no spaces in A & Eat least a & e cannot act surprised when you turn up with a patient


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