Transcript Document

Inquiry into Public Hospital Performance
Ambulance Victoria Presentation
2 December 2009
Ambulance Victoria representatives
• Greg Sassella
Chief Executive Officer
• Tony Walker
General Manager Regional Services
• Mark Rogers
General Manager Specialist Services
• Alex Currell
General Manager Strategy & Planning
Creation of Ambulance Victoria
• Government announced the creation of Ambulance
Victoria in April 2008
• Three previous services to merge into one:
– Alexandra and District Ambulance Service (ADAS)
– Rural Ambulance Victoria (RAV)
– Metropolitan Ambulance Service (MAS)
• Integration activities included:
– Implementation of $187m new initiatives announced
by govt.
– Negotiate EBA
– Begin integrating business and finance systems/IT
– Implement new organisational structure
Ambulance Services Act 1986
Part 4 – Ambulance Services
15. Objectives of ambulance services
The objectives of an ambulance service are –
(a) To respond rapidly to requests for help in a medical
emergency;
(b) To provide specialised medical skills to maintain life and to
reduce injuries in emergency situations and while moving
people requiring those skills;
(c) To provide specialised transport facilities to move people
requiring emergency medical treatment;
(d) To provide services for which specialised medical or transport
skills are necessary;
(e) To foster public education in first aid
Ambulance Victoria’s Role
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Ambulance Victoria is a critical link in Victoria’s health
care system and aims to improve the health of the
Victorian community by providing high quality pre-hospital
care and medical transport
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AV provides the following services:
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Emergency medical response, pre-hospital care & transport
Non-emergency patient transport
Major incident management & response
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Air ambulance
Adult retrieval services
Community education
Ambulance Membership Scheme (insurance)
Ambulance Victoria’s Resources
• Career staff (FTE)
– Over 2,400 operational paramedics
– Approx 275 operational managers & support staff
– Approx 320 administrative staff
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Approximately 1,000 volunteers
Over 550 ambulances & patient transport vehicles
4 fixed wing aircraft & 5 helicopters
224 response locations
$507 total revenue (2008-09)
– Operating Revenue; 54% Government, 18% Transport Fees,
17% Memberships, 1% Other
– Non Operating Revenue; 8% Capital, Other 2%
Ambulance Victoria activity 2008-09
• Total of 720,891 incidents requiring dispatch
• Total of 593,398 patients transported
– Road ambulance operations:
– 433,549 emergency incidents
– 280,813 non-emergency incidents
– 587,405 patients transported
– Air ambulance operations:
– 4,606 fixed wing transports
– 1,387 helicopter transports
– Adult Retrieval Victoria (ARV) operations:
– 1,584 medical retrievals
Ambulance Victoria performance measures
• Response time
– Measurement includes call answer to arrival at scene
• Quality of care
– Audits of paramedic treatment
– Satisfaction surveys
• Patient Outcomes
– Patient medical outcomes
• Satisfaction
– Community
– Health sector
– Patients
Ambulance & the health system
• Ambulance is an integral part of the health system
• Initial access to care for many emergency patients
• Emergency demand
– Average 5.5% pa since 2004-05
• Ambulance/ED presentations
– 26% of ED presentations by ambulance (major hospitals)
– 41% of Triage Category 1 to 3
• Ambulance role in demand management
– Metropolitan referral service for low priority callers
– No emergency ambulance dispatch to 7% of callers
– Meet patient needs, reduces ED and ambulance demand
Ambulance Response Time Components
• Telstra “000” call-taking and ambulance dispatch
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Emergency Services Telecommunications Authority (ESTA)
Call answer
Prioritise
Dispatch
• Response process
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Activation (crew alerted and responding)
Reflex (travel to the scene)
At scene (locate, treat, load patient)
Transport (from scene to hospital)
At hospital (triage, patient transfer and cleared time)
• Response Time (“Call Answer” to “At Scene”)
• Total Case Time (“Dispatch” until “Cleared”)
Ambulance/ED interface
• Performance at the ambulance/ED interface
– Direct impact on time for patients to access care
– Impact on ambulance availability & response time for next
emergency
• Key current processes to manage interface
– Hospital bypass
– Hospital Early Warning System (HEWS)
– Patient transfer escalation process
• Access & arrivals
– Pilot system currently under development (Arrivals Board)
– Real time sharing ambulance arrival & hospital capacity data
– Early preparation for arrival & early warning of delays
Patient Transfer Time- Escalation Process
• The time from ambulance arrival at ED to the time
patient is transferred from ambulance stretcher to ED
bed
– Delays at this interface affect ambulance availability
• Escalation of issues is dealt with in real time
– Ambulance Communications Centre alerted
– Frontline ambulance managers attend ED’s
• Patients cared for by paramedics when delays
experienced at ED
Improving system performance
• Victoria’s trauma system
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Ambulance triage to Major Trauma Service (MTS) if within 30 minutes
Minimise time to appropriate medical care
Reduction in risk of mortality from major trauma
Over 80% major trauma patients receive definitive care at an MTS
• Acute Coronary Syndrome patients
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Transmission of 12 lead ECG from scene to hospital
Pilot completed in 2008 & now rolled out to 9 hospitals
Early activation of hospital cardiac team
Ave ‘door to balloon’ time reduced from 106 min to 56 min at 90th
percentile (pilot)
– Funding received for statewide expansion of model
• Stroke patients
– Less formal arrangements to transport to specialist stroke units
– Improved paramedic identification of stroke