Base Hospitals Overview

Lecture 10: Base Hospitals

• Regional Base Hospital Program (Ontario) provides oversight, guidance, and quality control for prehospital emergency medical services in Ontario.
• Institutions involved: Sunnybrook, Durham, Ottawa, Hamilton, London, Sudbury, and Thunder Bay.
• Medical Delegation: Delegation of medical procedures and guidelines to paramedics.
• Medical Advice/Oversight: Ongoing guidance for paramedic teams.
• Continuous Medical Education (CME): Training for paramedics to stay updated on medical standards.
• Quality Assurance: Audits, evaluations, and patient safety checks.
• Program Planning: Aligning Base Hospital services with departmental and accreditation standards.
• Policies and Procedures: Establishing standards for patient care and documentation.
• Human Resources Management: Hiring standards and certification requirements for paramedics, evaluation of paramedic qualifications, system-wide training, certification maintenance, and clinical placements compliant with MOHLTC.

Paramedic Practice Status

• Practice Status Levels: Paramedics' ability to practice depends on their status within the Base Hospital.
• Status can be: Active, Provisional, Deactivated, or Decertified.
• Decertified: Permanent loss of practice privileges.
• Status changes are communicated to the relevant parties (paramedic, supervisor, operations manager, and MOHLTC).

Quality Assurance Measures

• ACR Audits: Evaluation of Ambulance Call Reports.
• ACE (Ambulance Call Evaluation): Regular patient safety evaluations.
• Follow-ups: Ensuring continuous improvement through follow-up checks.
• Quality Programs: Identifying contributory causes for incidents.
• Strategies for system improvement and practice enhancements.

Patient Safety and Critical Incident Examples

• Critical Safety Concerns: All aspects of patient safety are critically important.
• Drug mix-ups (e.g., Morphine vs. Epinephrine).
• Rhythm misinterpretations (shockable vs. non-shockable).
• Incident Analysis: Discovery of contributing factors (human factors, crew resource management, and clinical decision-making).
• Root Cause Analysis: Assessing errors using human factors and system design.

Human Factors in Patient Safety

• Definition: Study of factors impacting the ability to perform work correctly.
• Principle: Mistakes are common, and support systems are needed for error reduction.

Case Study – Just a Routine Operation

• Breakdown of: Teamwork, assertive communication, and leadership aspects highlighted as essential components affecting operations.

Paramedic and Combat Aviation - Comparison of Roles

• Similar Task Breakdown:
  • Combat Aviation: Aviate, Navigate, Communicate.
  • Paramedicine: Resuscitate (ABCs), Differentiate (diagnose), Communicate.
• Challenges: Task saturation or "Helmet Fire" (overwhelmed by tasks, leading to tunnel vision).

Crew Resource Management (CRM)

• Goals: Shared accountability and responsibility, joint decision-making, and open communication.
• Practice: Optimize team performance, minimize errors, and enhance patient outcomes.

System Design

• Evaluation of Competence.

Decision-Making in Clinical Settings

• Impact on Patient Safety: Influence of thought processes on patient outcomes
• Pat Croskerry's Contributions: research on decision-making in emergency medicine
• Healthcare Decision-Making Models: Rational (System 2), and Intuitive (System 1).
• Rationale - slow, deliberate, objective, scientific, fewer errors
• Intuitive - fast, autonomous - context dependant, qualitative - prone to error
  • System 2 (slow, deliberate, objective, more accurate, fewer errors)
  • System 1 (fast, automatic, more likely to error)

Just Culture

• Definition: A culture that emphasizes learning from mistakes instead of punishing them.
• Goals: Self-reporting of errors, and improving systems and practices for better patient safety.
• Components: Human factors, crew resource management, and system design.

Paramedicine – Vision and Advocacy

• Key Advocacy Questions: Who are we? What do we aim to achieve?, and when and how committed are we?
• IAFF (International Association of Fire Fighters): Role in Fire Fighters Political Association Committee, and labor relations are covered.
• Legislation and Regulation (MOH): Primary regulatory authority for paramedicine with mention of self-regulation and union influence.

Identity and Professional Development

• Key questions for paramedics: What are we? What do we want to become?
• Paramedic Education: Shift to extended programs, evidence-based and patient-centered education, and focus on competencies.

Current Challenges – Demand and Resources

• Code Zero: Demand exceeding resource availability, due to population increase, need for emergency service availability, and imbalance between call volume and resources.
• Offload delay issues lead to longer wait times.

Healthcare System Challenges

• Shortage of primary care physicians and aging physician workforce.
• Staffing shortages and recruitment insufficient to meet demand.

Proposals - Right Care, Right Time, Right Place

• Promote treatment alternatives for emergency department visits.

Funding and Cost Management

• Total healthcare spending Canada projected to reach $331 billion in 2022
• Major expenses: Hospitals, physicians, and drugs.
• Funding challenges: service recovery costs, cost-effectiveness factors, and inflationary impacts on operational costs.

Tension Points in Funding and Policy

• Slow-moving government processes.
• Liability concerns due to budget constraints.

EPIC Program (Community paramedicine)

• Study the types of medical conditions addressed by the Community Paramedics.
• Understand the role and goals of the Community Paramedics, noting their importance for community health.
• Review EPIC practices and pay attention to the medical conditions cared for.

Base Hospital Lecture - Objectives

• Overview of the Ontario Base Hospital System
• Components of the Base Hospital:
• Description of the role of Base Hospitals
• Paramedic's relationship with the Base Hospital
• Roles of the Base Hospital Committees and their duties.
• Delegation of Medical Acts

Base Hospital Design

• Components of the Base Hospital: Certification, Education, Professional Standards & Compliance, and Research.

Levels of Certification

• Educational institutions provide certificates
• Base hospitals verify paramedics to practice according to their medical director's license
• Paramedics are not licensed (in this context) in these national certifications:
  • Emergency First Responder
  • Primary Care Paramedic
  • Advanced Care Paramedic
  • Critical Care Paramedic

Medical Direction

• Medical Directives
• Online Direction

Delegation of Controlled Acts

• Regulated Health Professions Act (RHPA) and the regulated medical acts performed.
• Medical directors responsibilities and liabilities for medical delegation

Development of Medical Directives

• Developed by Local Base Hospitals and approved by the Medical Advisory Committee (MAC).
• Signing MD is responsible -- Evidence-based approach to directives
• Contact with MD, availability and procedures
• Documentation standards and QA (self-reporting)

Paramedic's Working Medical Status

• Paramedics' practice privilege depends on their Base Hospital status.
  • Status Levels: Active, Provisional, Deactivated or Decertified
• Changes of status communicated to Paramedic, Supervisor, Operations Manager, and MOHLTC.

Certification

• Initial Certification: Symptom relief and defibrillation testing.
  • Maintenance of Certification: Not inactive > 90 days , performing minimum 10 calls, completing 8 CME hours, and responding to all call audit requests from Base Hospital Physicians.
  • Causes of de-certification or loss of privileges.
  • Gross professional misconduct, falsification of documentation, gross negligence in patient care, failure to complete remediation

Additional Information

• Research includes retrospective reviews, randomized controlled trials (RCTs), field evaluations

Ethics Consideration: According to Week 10 Reading

• Ethics: Guiding principles influencing decision making in healthcare.
• Why study ethics?: Navigate complex decisions, Ensure patient-centered care, Build public trust, Guide professional behavior.
• Principles of Ethics: Autonomy, Beneficence, Non-Maleficence, and Justice.
• Application of Ethics in a Patient Encounter: Respecting patient autonomy, and practicing beneficence, avoiding harm
• Professional Values: Integrity, Compassion, Competence, Respect for patients, Confidentiality.
• Fairness: Treating each patient with unbiased consideration

This quiz provides an overview of the Regional Base Hospital Program in Ontario, detailing its role in emergency medical services oversight, medical delegation to paramedics, and continuous medical education. It explores the institutions involved, quality assurance practices, program planning, and human resource management pertaining to paramedic services.