Alberta Health Services mergency Medical Services Implementation Plan ecommendations and equired Actions from HQCA eview of the Operations of Ground mergency Medical Services in Alberta 2013/05/13 Medical Administrative Lead: Dr. Ian Phelps Manager: Tanya Sakamoto
ecommendations and equired Actions from HQCA eview of the Operations of Ground MS in Alberta ii xecutive Summary The Health Quality Council of Alberta (HQCA) publicly released its eview of the Operations of Ground mergency Medical Services in Alberta report on March 4, 2013. This report contains several recommendations and required actions that will be implemented by Alberta Health Services (AHS) to improve provincial ground ambulance services for Albertans. AHS mergency Medical Services (MS) is well positioned to respond to this report. Work is already underway on many of the recommendations and we have initiated additional projects where required to help move forward as a provincial MS system. In total, 21 projects have been identified as part of this MS HQCA implementation plan. These projects are summarized in the table below (refer to New Summary ). A project management approach will be used to monitor and complete this work, with each individual project having a project sponsor and project manager. In addition, the work in each project will be progressively elaborated through the project phases of initial concept, detailed concept, design, execution planning, execution and review. Current status and project completion is summarized in the High Level Timelines section below. Two of the projects identified have significant cost implications for which funds are being internally allocated by AHS. The Medical First esponse Program (equired Action 3.3, 3.3) estimates $535 000 one-time and annualized ongoing funding, with 3.5 FT required to support the program. Implementation of epc in Contracted Services (equired Action 4.3, 4.3.2) requires $2 042 000 one-time and $610 000 annualized ongoing funding. The dispatch consolidation project is being funded from the existing transition grant. An MS HQCA Implementation Steering Committee has been established, with accountability to AHS xecutive. In addition to AHS representatives, Alberta Health and Health Advisory Council representatives are members of the Steering Committee. managers for the 21 projects identified will provide monthly status updates to the Steering Committee. The Steering Committee will provide quarterly progress updates to Alberta Health and Health Quality Council of Alberta for the duration of the projects.
ecommendations and equired Actions from HQCA eview of the Operations of Ground MS in Alberta iii New Summary ecommendation 2. Alberta Health immediately reverse its decision to suspend the consolidation of the MS dispatch system into Alberta Health Services, and Alberta Health Services proceed with establishing a provincewide, consolidated MS dispatch system. 3. Alberta Health Services articulate a vision and plan for the MS delivery system and incorporate an MS delivery model that standardizes care across the province recognizing the unique realities and requirements for urban, rural, and remote areas. equired Description Action 2.1 Alberta Health Services establish two (2) MS dispatch centres to ensure a safe and reliable borderless MS dispatch system with adequate backup. 2.2 Alberta Health Services develop an improved change management plan to engage municipalities, MS service providers, and the public in the process of establishing and implementing the consolidated MS dispatch system within the provincial MS system. Articulate a vision and plan for the MS delivery system 3.1 stablish definitions for urban, rural, and remote areas taking into consideration geography, population demographics, frequency of time-sensitive calls, and distance to tertiary care facilities. New s Initiated Provincial Dispatch Consolidations Dispatch Consolidation Change Management Plan Develop Provincial MS Service Delivery Model Identifying the unique challenges that face MS operations highlighting the diverse needs of urban, rural and remote communities Data analysis of the location and frequency of time-sensitive events Develop definitions for urban, rural and remote areas Number Sponsor 2.1 Jim Garland Manager Wes Bogdane 2.2 Sue Conroy Jim Garland 3.0 Sue Conroy, Ian Phelps 3.1.1 Trevor Maslyk, Dale Weiss 3.1.2 Lyle McKellar, Sandy Halldorson 3.1.3 Trevor Maslyk Tanya Sakamoto ob Sharman Tony Pasich ob Sharman
ecommendations and equired Actions from HQCA eview of the Operations of Ground MS in Alberta iv ecommendation equired Description Action 3.2 nsure the most efficient and effective ambulance locations are determined based on validated MS data, geography, population demographics, frequency of timesensitive calls, and distance to tertiary care facilities. 3.3 Determine the role, required training and qualifications, for medical first responders within the MS delivery model. 3.4 Define the range of healthcare services to be provided by MS practitioners, including community paramedicine. 3.5 nsure the minimum standard across the province is a Basic Life Support ambulance. 3.6 Determine the resources required for inter-facility transfers (IFTs) that considers provider scope of practice, vehicle type and equipment based on patient need. New s Initiated Provincial Ambulance and Station Allocation Process Provincial Medical First esponse (MF) Framework Develop structure and recommendations related to the range of healthcare services MS practitioners provide both within MS and in nontraditional settings Basic Life Support (BLS) as a minimum standard across the province Inter Facility Transfer (IFT) coordination, pre-planning, and operational management eview Inter Facility Transfer (IFT) core services and service delivery model Number Sponsor 3.2 Jim Garland 3.3 Jim Garland 3.4 Darren Sandbeck 3.5 Lyle McKellar 3.6.1 Howard Snodgrass 3.6.2 Howard Snodgrass Manager Graham Vanderwater Graham Vanderwater Scott Holsworth Steve Sutton Steve Sutton
ecommendations and equired Actions from HQCA eview of the Operations of Ground MS in Alberta v ecommendation 4. Alberta Health and Alberta Health Services collaborate to establish a comprehensive, single source of valid MS system data that encompasses the MS dispatch and delivery systems to be used for operational decisionmaking as well as quality and safety management. 5. Alberta Health Services specify a quality and safety management approach that is an integral component of the AHS MS planning and equired Description Action 4.1 Alberta Health Services identify key patient outcome, process, and cost-effectiveness measures for emergency and nonemergency activities (e.g., interfacility transfers, community referral programs, community paramedicine) and for specific patient populations (e.g., major trauma, ST segment elevation myocardial infarction, stroke) and design the collection of provincial MS data to support the reporting of these measures. Consider national and international sources in their development. 4.2 Alberta Health and Alberta Health Services ensure that the MS data source can be linked with other healthcare databases to ensure the ability to report on patient outcomes and patient level costing. 4.3 AHS ensure contracted MS providers meet AHS MS reporting and data standards. 5.1 Develop and implement a comprehensive quality and safety management approach New s Initiated Identify key MS patient outcome, process and cost effectiveness measures Link MS data to other healthcare databases MS Contract Compliance Program epc ollout to Contracted Ground Providers Develop and implement a comprehensive quality and safety management approach Number Sponsor 4.1 Glenn Mcae 4.2 Glenn Mcae Manager Kim Liss Kim Liss 4.3.1 Marty Scott Shona O Connor 4.3.2 Sue TBD (Drew Conroy, Ian Doering) Phelps 5.1 Glenn Mcae Steen Pedersen
ecommendations and equired Actions from HQCA eview of the Operations of Ground MS in Alberta vi ecommendation performance documents. equired Action Description New s Initiated Number Sponsor Manager Ministerial Directive 2.1 Specific provisions to minimize MS staff wait times in emergency departments at Alberta s seven major hospitals. Creation of a provincial mergency Medical Services/ mergency Department committee to address provincial initiatives and flow strategies MS representation on D Site Specific Quality Improvement Committees eview of current provincial Urgent Care Centre (UCC) criteria 2.1.1 2.1.2 2.1.3 Darren Sandbeck Dale Weiss Darren Sandbeck 2.2 Options to limit the use of AHS MS staff and contracted MS resources for non-urgent interfacility transfers, including the use of external contractors to provide these services. Feasibility study and review of processes for patient prioritization between MS and waiting room patients in mergency Departments None (see 3.6) 2.1.4 Dale Weiss
ecommendations and equired Actions from HQCA eview of the Operations of Ground MS in Alberta vii High Level Timelines A project management approach is being applied to the work being undertaken as part of the MS HQCA implementation plan. The work in each project will be progressively elaborated through the project phases of initial concept (), detailed concept (), design (D), execution planning (), execution () and review (). After each project's design phase, a detailed execution plan will be completed. This high-level project timeline is intended for program planning and resource allocation only. # Name 2.1 Dispatch Consolidation 2013 2014 2015 M A M J J A S O N D J F M A M J J A S O N D J F M - 2.2 Dispatch Consolidation Change Management Plan 3.0 3.1.1 3.1.2 Develop MS Provincial Service Delivery Model Identifying the unique challenges that face MS operations highlighting the diverse needs of urban, rural and remote communities Data analysis to help identify the frequency and location of time-sensitive events D D D D D D D D D D D D / D D 3.1.3 Develop definitions for urban, rural and remote areas / D D / Delay closeout pending completion of other projects 3.2 3.3 Provincial Ambulance and Station Allocation Process Provincial Medical First esponse Framework /D D C D D D D D D D D /
ecommendations and equired Actions from HQCA eview of the Operations of Ground MS in Alberta viii # Name 3.4 3.5 3.6.1 3.6.2 4.1 4.2 4.3.1 4.3.2 5.1 2.1.1 Develop structure and recommendations related to the range of healthcare services MS practitioners provide nsure the minimum standard across the province is a BLS ambulance IFT coordination, preplanning, and operational management eview IFT core services and service delivery model Identify key MS process, patient outcome and cost effectiveness measures Link MS data to other health datasets MS Contract Compliance Program epc ollout to Contracted Ground Providers Develop and implement a comprehensive quality and safety management approach Creation of a provincial MS/D committee to address provincial initiatives and flow strategies 2013 2014 2015 M A M J J A S O N D J F M A M J J A S O N D J F M D D D D D D / / / D D D D D D D D D- /D / D D D /D / Note: This project can be completed in 12 months after funding is approved and released. D D D D
ecommendations and equired Actions from HQCA eview of the Operations of Ground MS in Alberta ix 2.1.2 2.1.3 2.1.4 # Name MS representation on D Site Specific Quality Improvement Committees eview of current provincial Urgent Care Centre criteria Feasibility study and review of processes for patient prioritization between MS and waiting room patients in D 2013 2014 2015 M A M J J A S O N D J F M A M J J A S O N D J F M D D