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Emergency Medical Care-A Systems Approach PowerPoint Presentation

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Description : Check out this medical presentation on Emergency Medical Services (EMS), which is titled "Emergency Medical Care-A Systems Approach", to know about a Systems Approach to Emergency Medical Care.

Tags : Emergency Medical Services, EMS, Emergency Medical Care, Systems Approach

Published on : Aug 10, 2021 | Views : 2044 | Downloads : 8

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Slide 1-

8/12/2021 Bill Jermyn, DO, FACEP Emergency Medical Care-A Systems Approach Bill Jermyn, DO, FACEP
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8/12/2021 Bill Jermyn, DO, FACEP A Little History
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8/12/2021 Bill Jermyn, DO, FACEP 1966 “Local political authorities have neglected their responsibility to provide optimal emergency services.” “Adequate ambulance services are as much a municipal responsibility as firefighting and police services.” “Emergency departments of hospitals are overcrowded, some are archaic….” “…research in shock and trauma is inadequately supported.”
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8/12/2021 Bill Jermyn, DO, FACEP 1966 “Under medical leadership, national forums should be conducted at the highest levels on all subjects important to total emergency care from the time of receipt of an injury through rehabilitation.” “The general public is insensitive to the magnitude of the problem of accidental death and injury.”
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8/12/2021 Bill Jermyn, DO, FACEP 1985 “The committee believes that injury is a public health problem whose toll is unacceptable. The time has come for the nation to address this problem—a problem that affects all Americans and one which an investment in research could yield an unprecedented public health return.”
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8/12/2021 Bill Jermyn, DO, FACEP 2001 “…emergency departments are overwhelmed ….” “The problem is that the supply of care has been choked back.” “…another could be to recognize emergency medical care as an essential public service, one that should be provided to every community….”
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8/12/2021 Bill Jermyn, DO, FACEP 2003 “Emergency Department crowding is not an issue that can be solved in the ED alone.Rather, it is a complex issue that reflects the broader health care market. It is clear that, as a key part of the health care safety net, ED’s in many of the nation’s largest cities are under strain.” GAO March 2003 HOSPITAL EMERGENCY DEPARTMENTS Crowded Conditions Vary among Hospitals and Communities GAO-03-460
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8/12/2021 Bill Jermyn, DO, FACEP January 2006 “Local emergency departments are at the front line of this national crisis.” “…they must wait in emergency department hallways for hours and sometimes days.” “…emergency medicine systems in many states are under extreme stress.” ‘Policymakers, physicians, and the general public should take note and take steps to address the shortcomings….” The National Report Card on the State of Emergency Medicine American College of Emergency Physicians www.acep.org
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8/12/2021 Bill Jermyn, DO, FACEP 14 June 2006 “…the nation’s emergency medical system is overburdened, underfunded, and highly fragmented….” “This crisis is multifaceted and impacts every aspect of emergency care—from prehospital EMS to hospital-based and trauma care. The American public places its faith in the ability of the emergency care system to respond appropriately whenever and wherever a serious illness or injury occurs. But while the public is largely unaware of the crisis, it is real and growing.”
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8/12/2021 Bill Jermyn, DO, FACEP 1966-2006 40 years and nothing has changed! This “crisis” affects 35% of our citizens every year I’m tired of saying the same old thing. To get a different outcome, we have to change our approach What do we need to do differently?
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8/12/2021 Bill Jermyn, DO, FACEP 1966-2006 We must develop the political will to fundamentally change the system. That change requires that we all have the same concept of an Emergency Medical Care System (EMCS). You cannot develop political will if you don’t know what you’re selling.
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8/12/2021 Bill Jermyn, DO, FACEP
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8/12/2021 Bill Jermyn, DO, FACEP What Do We Have Now? Silos and “Silo Mentality”
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8/12/2021 Bill Jermyn, DO, FACEP
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8/12/2021 Bill Jermyn, DO, FACEP Our current system evolved from individual, disparate components. Therefore, it isn’t surprising that they operate and think separately—in their own silo. The only entity that examines all of the care provided is the hapless patient.
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8/12/2021 Bill Jermyn, DO, FACEP A Little Perspective
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8/12/2021 Bill Jermyn, DO, FACEP
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8/12/2021 Bill Jermyn, DO, FACEP Missouri 2004 1.75 Million ED visits (35% of population) 500,000 ambulance transports (10% of population) Unknown number of “non-transport” ambulance calls– Depending on the service, this varies from 5-40% additional volume
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8/12/2021 Bill Jermyn, DO, FACEP FY 2006-A Tale of Two (MO) Cities *-Does not include grants or special taxes
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8/12/2021 Bill Jermyn, DO, FACEP Trauma System Funding-2007
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8/12/2021 Bill Jermyn, DO, FACEP Efficiency Model Since the 1970’s, we have expected the medical care system to be efficient and have little excess capacity The problem is that the emergency medical care system was lumped into the model “Piece work” reimbursement Unintended consequence is little ability to increase capacity/surge
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8/12/2021 Bill Jermyn, DO, FACEP What Happened? Since 1986, move to outpatient therapy and earlier discharges from the hospital (HMO’s, PPO’s, etc) Result was fewer hospital beds Community Hospitals: 1975: 424 beds/100,000 population 2003: 280 beds/100,000 population
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8/12/2021 Bill Jermyn, DO, FACEP What Happened? 1990-1999: Hospitals lost 103,000 inpatient medical/surgical beds and 7,800 ICU beds nationally. 1992-2003: ED visits increased by 26% (90 to 114 million/year) while the number of ED’s dropped by 14%. This has significantly increased the patient load of the remaining facilities.
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8/12/2021 Bill Jermyn, DO, FACEP What Do We Have Now? Day to day capacity is strained-crowding and ambulance diversion (every minute of every day) Boarding of admitted patients in the ED, ED crowding, and ambulance diversion Rehab and Long Term care constraints restrict hospital discharges National problem
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8/12/2021 Bill Jermyn, DO, FACEP What Do We Have Now? 2003 ACEP survey: 80% respondents said their ED’s lacked surge capacity because of crowding, boarding, and a lack of on-call specialists The shift to outpatient therapy has severely taxed our ability to respond when the system fails
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8/12/2021 Bill Jermyn, DO, FACEP Why? Healthcare is not funded for surge capacity. Encouraged to be 100% efficient. We need to develop a way to assist the emergency portion with their ability to surge properly.
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8/12/2021 Bill Jermyn, DO, FACEP Take Home Medical system at capacity daily There is little integration or coordination of the overall system There is even less funding for the system There is no overall plan for what we want
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8/12/2021 Bill Jermyn, DO, FACEP What Are The Potential Savings? Hard to Quantify
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8/12/2021 Bill Jermyn, DO, FACEP
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8/12/2021 Bill Jermyn, DO, FACEP
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8/12/2021 Bill Jermyn, DO, FACEP Traffic Related Deaths
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8/12/2021 Bill Jermyn, DO, FACEP Traffic Related Deaths
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8/12/2021 Bill Jermyn, DO, FACEP 1. Why is the rural MVC death rate increased by a factor of 10? (5.4/100K vs. 52.6/100K) 2. Should we be proactive about Automatic Crash Notification? 3. Should we work on inappropriate care? 4. Can MO CALS affect this?
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8/12/2021 Bill Jermyn, DO, FACEP 2003 MICA (MO Information for Community Assessment) Data
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8/12/2021 Bill Jermyn, DO, FACEP In 2003: For Ischemic Heart/Brain Disease, and Trauma; 8 Diagnoses: Total charges are $3 Billion!
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8/12/2021 Bill Jermyn, DO, FACEP If we can improve care and decrease charges only by 0.5% (1/200), it is a savings of $15 million per year. And this is just acute care hospitalization charges! What about long term care savings?
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8/12/2021 Bill Jermyn, DO, FACEP 2003 Missouri Deaths
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8/12/2021 Bill Jermyn, DO, FACEP 2003 Missouri Deaths 1% of these four diagnoses is 223 lives saved. A high performance system should be able to improve more than 1%! MO CALS tPA for stroke Primary PCI or lytics for STEMI Timely Trauma Triage
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8/12/2021 Bill Jermyn, DO, FACEP Time Critical Diagnosis System Three diagnoses; sick trauma, stroke, STEMI- The “Big Three” Right patient, right place, right time, right care Expand the current trauma system to include strokes and STEMI’s. Not TIA’s, all strokes, NSTEMI’s, UA or chest pain, minor traumas
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8/12/2021 Bill Jermyn, DO, FACEP Time Critical Diagnosis System We have clear evidence that timely and appropriate treatment of these three diagnoses can improve patient outcomes. (20:80 rule) Small numbers of patients--patients who would be transferred to a regional center anyway so it doesn’t threaten the CAH’s. A focus on symptom onset to definitive care
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8/12/2021 Bill Jermyn, DO, FACEP Case Example-2 It Can Work Location: Rural county- 22 miles out 1050 hrs: Middle aged male develops chest pain PMH: HTN 1051: Call received 1054: Alert dispatcher activates ground and air by the criteria we have all agreed upon through SAC
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8/12/2021 Bill Jermyn, DO, FACEP Case Example-2 1121: Air crew arrives at patient side 1130: Depart scene-12 lead shows inferior ST-Elevation Myocardial Infarction (STEMI) Enroute, standard care administered, and hospital notified 1158: Arrive hospital Cardiologist meets patient in ED, brief exam, and transfer to cath lab
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8/12/2021 Bill Jermyn, DO, FACEP Case Example-2 Cath team has cleared a table prospectively 1225 Needle time 1235 Lesion time 1237 Balloon time LOS -2 days! Post cath EF >50%
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8/12/2021 Bill Jermyn, DO, FACEP Case Example-2 Savings Acute: 1-2 days on LOS, $5-15,000 Long Term: Who knows how many hundreds of thousands of dollars? We saved the function of a patient who is back at work as a productive member of society instead of on disability. Estimated total health care expenditures on disability for 30 years is $345,000.00
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8/12/2021 Bill Jermyn, DO, FACEP Think About These Points This case demonstrates what can happen when we all work together. A patient had a symptom onset to balloon time of 107 minutes—from rural Missouri! Outstanding!