Base Hospital Notes PDF

🏥 Lecture 10: Base Hospitals Regional Base Hospital Program (Ontario) – Roles & Responsibilities in Prehospital Care 1. Overview Purpose: Base Hospital programs provide oversight, guidance, and quality control for...

🏥 Lecture 10: Base Hospitals Regional Base Hospital Program (Ontario) – Roles & Responsibilities in Prehospital Care 1. Overview Purpose: Base Hospital programs provide oversight, guidance, and quality control for prehospital emergency medical services in Ontario. Institutions: Sunnybrook, Durham, Ottawa, Hamilton, London, Sudbury, Thunder Bay. 2. Key Responsibilities of the Regional Base Hospital Program Medical Delegation: Delegation of medical procedures and guidelines to paramedics. Medical Advice/Oversight: Ongoing guidance for paramedic teams. Continuous Medical Education (CME): Training to ensure paramedics stay updated on medical standards. Quality Assurance: Audits, evaluations, and patient safety checks. 3. Program Planning Planning: Align Base Hospital services with departmental and accreditation standards. Policies & Procedures: Establish standards for patient care and documentation. Lecture 10: Base Hospitals 1  Ensure consistent communication practices. ( Medical Delegation & Medical Oversight-Advice) 4. Human Resources Management Staffing: Hiring standards and certification requirements. Evaluation of paramedic qualifications. Ongoing Education: System-wide training. Certification maintenance. Clinical placements and MOHLTC compliance. 5. Paramedic Practice Status Practice Status Levels: A Medic’s privilege to practice is dependant on his/her status within the Base Hospital The Medic’s may be Active, on Provisional status, Deactivated or Decertified The paramedics, their Supervisor, Operations Manager and the MOHLTC will be notified of any status change Decertified: Permanent loss of practice privileges. Status Notifications: Status changes are communicated to the paramedic, their supervisor, operations manager, and MOHLTC. 6. Quality Assurance Measures ACR Audits: Evaluation of Ambulance Call Reports. ACE (Ambulance Call Evaluation): Regular patient safety evaluations. Lecture 10: Base Hospitals 2  Follow-ups: Ensure continuous improvement through follow-up checks. Quality Programs: Identification of contributory causes for incidents. Strategies for system and practice improvements. 7. Patient Safety and Critical Incident Examples Critical Safety Concerns: → Everything is about pt safety Drug mix-ups (e.g., Morphine vs. Epinephrine). Rhythm misinterpretations (shockable vs. non-shockable). Incident Analysis: Discovery of multiple contributing factors (human factors, crew resource management, clinical decision-making). Root Cause Analysis: Assessing errors through the lens of human factors and system design. 8. Human Factors in Patient Safety Definition: Study of factors that impact the ability to perform work correctly, including interactions between humans, equipment, and the environment. Principle: Emphasizes that mistakes are common, and support systems are necessary to reduce error. 9. Case Study – Just a Routine Operation (Illustrates Human Factors) Breakdown of: Emphasis on teamwork and assertive communication. Highlights pitfalls such as: Lack of leadership. Lecture 10: Base Hospitals 3  Situational awareness and tunnel vision. Prioritizing basics (ABCs) in emergencies. Decision-making under pressure, including considering worst-case scenarios. Communication and assertiveness in high-stress situations. 10. 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). 11. Crew Resource Management (CRM) Goals: Shared accountability and responsibility. Joint decision-making and decision confirmation. Open, safe communication to foster a collaborative environment. CRM in Practice: Designed to optimize team performance, minimize errors, and improve patient outcomes. 12. System Design Evaluation of Competence: Lecture 10: Base Hospitals 4  Role expectations in various scenarios. Transition of Care (TOC) between Primary Care Paramedics (PCP) and Advanced Care Paramedics (ACP). System Optimization: Ensuring system design supports patient care and minimizes errors. 13. Decision-Making in Clinical Settings Impact on Patient Safety: How thought processes affect patient outcomes. Pat Croskerry’s Contributions: Research on decision-making in emergency medicine. Emphasis on the influence of context in clinical decisions. HealthCare Decision-Making Models: Rational (System 2): Slow, deliberate, objective, scientific, fewer errors. (we consider using, to gather data and make the best decision) Intuitive (System 1): Fast, autonomous, context-dependent, Qualitative, more prone to errors. 14. Just Culture Definition: A culture that emphasizes learning from mistakes instead of punishing them. Goals: Encourages self-reporting of errors and near misses. Focuses on improving systems and practices for enhanced patient safety. Components: Human factors. Crew resource management. System design. Lecture 10: Base Hospitals 5  Decision-making in healthcare. PARAMEDICINE Paramedicine – Vision and Advocacy 1. Key Advocacy Questions Who are we as paramedics? What do we aim to achieve? When do we seek these changes? How committed are we to these goals? 2. IAFF (International Association of Fire Fighters) Role Fire PAC(Political Association Committee) and labor relations. Lobbying efforts. EMS morale issues summarized humorously as, "the beatings will continue until morale improves." Legislation & Regulation 1. Ministry of Health (MOH) Primary regulatory authority for paramedicine. 2. Self-Regulation and Union Influence Potential for self-regulation in the field. Role of labor unions in advocating for paramedic needs and improving work conditions. 3. Competency and Qualifications Emphasis on maintaining high standards for paramedic skills and qualifications. Lecture 10: Base Hospitals 6  4. Identity and Professional Development Key questions for paramedics: Who are we in our professional identity? What do we want to become? 5. Paramedic Education Shift to extended programs MTCU (Ministry of … (from 2-year to 3-year programs). Focus on competencies that are: Evidence-based and patient-centered. Address community needs and system requirements. Current Challenges – Demand and Resources 1. Code Zero: Demand exceeding resource availability. We expect our call volume to go up 225% as population starts to increase Imbalance between call volume and resources. Offload delay times increasing, causing longer waits for emergency service availability. 1. Increasing Demand for Emergency Services Public awareness on appropriate 911 usage. Education on fall prevention and access to healthcare. Growing clinical care needs, influenced by aging populations and socio- cultural factors. Call Volumes, Delay in Hospital (OLD), Hospital system ($$$), Antiquated Models, Corruption, Socio-Cultural, Aging Population 2. Specific Statistics on Call Volume Lecture 10: Base Hospitals 7  Aging population leading to exponential increases in demand for emergency services. Predicted escalation in call volumes, especially from older age groups (70- 84, 85+). Healthcare System Challenges 1. Shortage of Primary Care Physicians Aging physician workforce, with many retiring soon. Estimated 1,100 primary care physicians needed in Central LHIN (Local Health Integration Network) to maintain current patient-to-physician ratios. Recruitment rates insufficient to meet future demand. 2. Chief Complaints by Age Group (Emergency Dispatch) Common complaints include: Constipation, diabetic emergencies, dizziness, fever, general malaise, nausea/vomiting, etc. Often, patients dispatched as "generally unwell." Proposed Solution: Right Care, Right Time, Right Place 1. Goals Provide healthcare alternatives to emergency department visits. Reduce patient and caregiver stress. Improve access to community health resources, minimizing exposure to hospital-based infections. 2. Research Findings Traditional paramedicine largely addresses non-emergent cases. Expansion of paramedic scope to primary care skills could reduce emergency department (ED) burdens. Lecture 10: Base Hospitals 8  Models such as "Treat and Release" and "Community Paramedics" for non-urgent cases. the goal is to try and keep people in their home and provide care for them their and everything doesn’t have to be at the hospital New directive is allowing pcp to allow pt to stay home if they are feeling better and not have to transport for no reason 3. Diversion Diversion allows better distribution of health and wealth. taking pt to places they need to be instead of taking pt to emerge all the time. Funding and Cost Management 1. Healthcare Spending Overview Total health spending in Canada projected to reach $331 billion in 2022 (~$8,563 per Canadian). Major expenses: Hospitals (24.34%), physicians (13.60%), drugs (13.58%). Canadian healthcare system rated modestly on quality but ranks high in cost relative to GDP. 2. Funding Challenges Cost of service recovery, cost-effectiveness, and inflation affecting operational costs. Trade-offs in the "cost-quality-time" triangle (e.g., higher quality can increase time and cost). As we focus on or lean toward one, the other changes as well. higher quality causes longer time and higher costs. Lecture 10: Base Hospitals 9  3. Tension Points in Funding and Policy Slow-moving government processes. Government don’t care about us, they only care about themselves. Systems theory considerations. Liability concerns and budget constraints ("Grabbing Hands" effect). Final Points for Terminal Evaluation (Topics to Focus On) 1. EPIC Program ( Community paramedicne Study the types of medical conditions addressed. Understand the role and goals of Community Paramedics, emphasizing their necessity for community health. Read about EPIC Pay close attention to the medical conditions they care for. What is a Community Paramedic, why do we need the program? What are the goals of the program? Base Hospital Lecture Objectives Provide an overview of the Ontario Base Hospital System. Define the components of the Base Hospital. Describe the role of Base Hospitals. Lecture 10: Base Hospitals 10  Explain a paramedic’s relationship with the Base Hospital. List the Base Hospital Committees and their roles. Discuss Delegation of Medical Acts. Base Hospital Design Components of the Base Hospital: 1. Certification 2. Education 3. Professional Standards & Compliance 4. Research Levels of Certification Educational institutions provide certificates or diplomas to indicate that students have met the educational requirements (Colleges). Base hospitals certify paramedics to practice under the license of their medical director. Paramedics are not licensed. National Levels of Certification: 1. Emergency First Responder 2. Primary Care Paramedic 3. Advanced Care Paramedic 4. Critical Care Paramedic Medical Direction 1. Medical Directives 2. On-line Direction Lecture 10: Base Hospitals 11  Delegation of Controlled Acts The Regulated Health Professions Act (RHPA) has governed the medical profession since 1993. There are 13 controlled acts, 12 of which are performed by the medical director. The College of Physicians and Surgeons has policies in place for delegation. Medical directors are vicariously liable. Principles of Delegation: Provide the best quality care in a timely manner. Consider the multidisciplinary team. Optimize the use of healthcare resources and personnel. Ensure actions are in the patient’s best interest. Responsibility for delegation always lies with the MD—not nurses or other paramedics. Physician Responsibilities Establish a physician-patient relationship. Delegate acts that are part of their regular practice. Ensure the individual receiving the delegation is capable, knowledgeable, and skilled. Identify risks involved. Ensure documentation requirements are met. Ensure informed consent. Consider liability. Ensure proper supervision. Your Responsibilities Lecture 10: Base Hospitals 12  Assess the situation to determine the need. Perform the intervention. Evaluate the effectiveness and the need for further intervention. Accurately document and report/relay information (e.g., assessment findings, ECG) to on-line MDs. Recognize the role of RHPA as it pertains to paramedics. Function effectively in a split crew configuration. Always prioritize being a patient advocate. Development of Medical Directives Developed by Local Base Hospitals and approved by the Medical Advisory Committee (MAC). Signing MD is responsible. Evidence-based. Contact with MD must be available for those certified to perform certain procedures. Documentation standards and QA (self-reporting) are required. Your Liability Failure to accurately report information (e.g., ECG, assessment findings). Failure to follow direction. Stepping outside of directives. Performing a skill without certification. Failure to update medical control regarding changes (e.g., patient presentation). Paramedic’s Working Status Lecture 10: Base Hospitals 13  A paramedic’s privilege to practice depends on their status within the Base Hospital. Status may be: 1. Active 2. Provisional 3. Deactivated 4. Decertified Changes in status are communicated to the Paramedic, Supervisor, Operations Manager, and the Ministry of Health and Long-Term Care (MOHLTC). Active Status Full practicing privileges. Provisional Status Can use all practice privileges but must report all calls involving delegated procedures to the Supervisor and Base Hospital. Ambulance Call Report (ACR) must be forwarded within two working days for review. Deactivation Prohibits performance of any medical delegated acts. Specific to the Base Hospital issuing deactivation. Medic cannot work on an ambulance while deactivated (per EHS policy). Deactivation can involve demotion to a lower certification level at the discretion of the Base Hospital Medical Director (BHMD). Decertification Prohibits performance of any medical delegated acts. Rare (1 case in 10 years). Lecture 10: Base Hospitals 14  Causes include: Gross professional misconduct. Falsification of documentation. Gross negligence in patient care. Failure to complete remediation. Repeated deactivations. Decertification can lead to permanent loss of privileges. Requires an Ad Hoc Paramedic Practice Review Committee. Certification Initial Certification: Symptom relief and defibrillation testing. Maintenance of Certification: Must not be inactive for more than 90 days. Perform a minimum of 10 calls at their skill level. Complete 8 hours of Continuing Medical Education (CME). Respond to all call audits by Base Hospital Physicians (BHP). Research Includes: 1. Retrospective reviews. 2. Randomized Controlled Trials (RCTs). 3. Field Evaluations. Additional Information Lecture 10: Base Hospitals 15  MOH – Base Hospital Roles and Responsibilities Publication:http://www.cpso.on.ca/policies/policies/default.aspx?ID=155 Ethics Consideration: According to Week 10 Reading Take some time with the article that is in the week 10 shell on Professionalism. And consider the following points for the test; What are Ethics? Ethics are a set of moral principles or values that influence decision-making and behavior. In healthcare, ethics provide a framework for determining what is right and wrong when caring for patients. For paramedics, ethics guide professional conduct, ensuring that actions prioritize patient welfare, respect human dignity, and uphold public trust. Ethics go beyond legal requirements, focusing on doing what is morally correct in complex or uncertain situations. Why Study Ethics? Studying ethics is crucial for healthcare professionals because it equips them to: 1. Navigate complex decisions: Paramedics often face high-stakes, fast-paced situations where ethical dilemmas arise (e.g., deciding whether to respect a patient's refusal of treatment when their life is at risk). 2. Ensure patient-centered care: Ethics promote respect for patients’ autonomy, beliefs, and rights. 3. Build public trust: Ethical behavior fosters trust in the paramedic profession and ensures accountability. 4. Guide professional behavior: Understanding ethics helps paramedics maintain integrity and professionalism, even under pressure or in challenging scenarios. What are the 4 Principles of Ethics? Lecture 10: Base Hospitals 16  The four foundational principles of ethics in healthcare are: 1. Autonomy: Respecting the patient’s right to make informed decisions about their own care. For example, if a patient refuses treatment after being fully informed of the consequences, their choice must be honored (as long as they are competent). 2. Beneficence: Acting in the best interest of the patient. This means providing care that benefits the patient, whether by alleviating pain, improving health, or preventing harm. 3. Non-Maleficence: "Do no harm." This principle emphasizes avoiding actions that could cause unnecessary harm or suffering to the patient. For instance, administering treatments that carry undue risk without clear benefit would violate this principle. 4. Justice: Treating all patients fairly and equitably, regardless of their background, socioeconomic status, or personal characteristics. Justice ensures that resources, care, and attention are distributed without discrimination. How Could Ethics Be Applied in a Patient Encounter? Ethics come into play in every patient encounter through the decisions paramedics make, such as: 1. Respecting Autonomy: Asking for informed consent before administering treatment, even in emergencies. 2. Practicing Beneficence: Choosing actions that improve the patient’s outcome, such as providing the most effective and timely treatment. 3. Avoiding Harm: Being cautious with interventions to minimize side effects or unnecessary discomfort. Lecture 10: Base Hospitals 17  4. Ensuring Fairness: Giving equal attention to every patient, regardless of personal biases or external factors like race, age, or economic status. Example: Suppose a paramedic encounters a terminally ill patient with a do-not- resuscitate (DNR) order. Respecting the DNR would uphold the patient's autonomy and non-maleficence, even if family members emotionally push for resuscitation. What are Professional Values? Professional values are the ethical standards and principles that guide behavior and decision-making within a professional context. In paramedicine, professional values include: 1. Integrity: Being honest and accountable for one’s actions. 2. Compassion: Demonstrating empathy and understanding toward patients and their families. 3. Competence: Maintaining the knowledge and skills necessary for high-quality care. 4. Respect: Valuing the dignity, rights, and beliefs of every individual. 5. Confidentiality: Protecting the privacy of patient information. By adhering to professional values, paramedics not only deliver better care but also maintain the trust and respect of the communities they serve. Lecture 10: Base Hospitals 18