Lecture 10: Base Hospitals 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. Systems theory considerations. Liability concerns and budget constraints ("Grabbing Hands" effect). Final Points for Terminal Evaluation (Topics to Focus On) 1. EPIC Program Study the types of medical conditions addressed. Understand the role and goals of Community Paramedics, emphasizing their necessity for community health. Lecture 10: Base Hospitals 10