In a report delivered to the Fort Worth City Council on July 20, a third-party consultant detailed his analysis of MedStar’s performance as part of a review process initiated by the City of Fort Worth. The assessment was designed to evaluate current performance, compare the performance to other EMS models and make recommendations based on the findings. And the results?
MedStar was confirmed as the best system for the City and performance has dramatically improved!
"The report is very positive and complimentary of MedStar’s recent achievements," says MedStar Executive Director Jack Eades. "It also recommends that the City of Fort Worth continue the agreement with MedStar in the future." Overall, the report praises MedStar for outstanding accomplishments over the past 2 years since the publication of the previous assessment report in 2008.
The report specifically mentions state-of-the art equipment, reduced costs, innovative practices that improve performance as contributing factors to "MedStar's response time reliability in Fort Worth [being] better than it has been in the past two decades."
The following are selected excerpts from the report. A link to the full report can be found at the end of the text.
"Today, MedStar is largely compliant with the operational performance standards set by the AMAA Board. Due to the elimination of the overload calculation, MedStar’s response time reliability in Fort Worth is better than it has been at any time in the past two decades."
"Response time reliability reported today as 90% is comparable to 94 to 95% using the overload calculation in previous years."
"Additionally, thoughtful expansion of the Community Health Paramedic Program has potential to preserve operational resources, reduce needless responses and improve access to healthcare resources for an underserved portion of the community."
"After MedStar, acting on a recommendation from the Fitch Report, hired an experienced Associate Director to run the operation, the organization began to produce the operational results and reliability that it was designed to accomplish."
"MedStar has begun to effectively address personnel concerns through remediation and replacement of some paramedic and staff that are performing below expectations. These efforts must continue."
"Continuing changes in management and methods have allowed MedStar to continually improve its performance."
"New services such as the Community Paramedic Program are beginning provide new patient centered healthcare service while reducing costs."
"During the past year, MedStar has made substantial progress in fixing the deficiencies that caused its past poor performance. The most visible measure of ambulance provider performance is response time reliability. There is much debate within the industry about the clinical value of short response intervals. Some studies seem to indicate that rapid response times are not very important to patient survival while other studies indicate that they may be very important for a small number of patients."
"MedStar has employed a number of industry best practices and has initiated its own innovations to improve its performance and efficiency. Processes such as pre-alerting crews to calls while still gathering information and highly efficient shift start and stop procedures are models for the industry."
"Supplies, equipment and maintenance practices are state of the art."
"The Community Health Paramedic Program, which uses an advanced practice paramedic to assist “frequent flyer” patients to access healthcare resources, is a novel and important service that steers patients to the right service without having to activate the 911 system. Expansion of this program to assist homeless shelters and other concentrations of medically fragile people has great potential to deliver more appropriate services to the public while reducing long term costs and preserving emergency resources for real emergencies."
The Polaris Group did find one or two items MedStar can focus on for improvement, as indicated by the following statements in the report:
"During rideouts with the Fort Worth Fire Department, the consultant noticed behavior of several MedStar paramedics that did not meet typical expectations for a clinically advanced EMS service."
"Some ambulance crews seemed passive or even disinterested on scene."
"In one case, the MedStar paramedic stood across the room from a patient that demonstrated potentially dangerous symptoms while the BLS Fort Worth Fire engine company completed an assessment of the patient. Without even having touched the patient or conducted any assessment of his own, the paramedic’s first words on scene were: “So do you want to go to the hospital?”
"On another call, another MedStar paramedic approached a patient carrying a computer but no clinical equipment. Some paramedics seemed aloof and not very involved in the evaluation and care of the patient while we were on scene."
"At no time did we witness that this behavior caused any injury to any patient."
"These are anecdotal incidents and it is difficult to tease a systemic problem out of a few observed actions.
In discussions with Fort Worth firefighters, MedStar paramedics and management and Dr. Beeson, it became clear that these incidents do indeed represent a recognized problem within the system."
"The behavior observed and described in interviews is often explained as “paramedic burnout.”
"This behavior is often blamed on high productivity, fatigue, management and frequent encounters with patients with minor complaints. If those were the causes of “paramedic burnout,” then a lot more paramedics would suffer from it. But in very many systems, that kind of behavior is not often found."
"Both the MedStar Associate Director and Dr. Beeson confirmed that they have observed the same disappointing behavior in the field and have been trying to change it."
"Subsequent to our discussions, MedStar and EPAB have taken several significant steps designed to resolve this problem and communicate higher expectations to the field personnel."
"Those actions have included changes in Management personnel, a new “back to basics” clinical program and initiation of a program known as “Grand Rounds.” Both Matt Zavadsky and Dr. Beeson continue to work shifts on ambulances and to respond to calls to augment Field Supervisors and monitor the performance of the crews. Finding some caregivers who don’t care was the single most disturbing finding in the investigation phase of this study."
"We believe that EPAB and MedStar management are taking significant and appropriate steps to fix this problem. We also encountered many more MedStar employees who were enthusiastic and diligent in their work, indicating that this problem is only demonstrated in a small number of the staff."
"MedStar should identify and remediate those individuals, or replace them."
"The Fitch report itemized friction between the clinical staff at EPAB and at MedStar as an item in need of resolution. Operational management and the Medical Director appear to have largely resolved this issue. Recent changes in MedStar clinical management seem to be a positive development in this regard as well."
"The Polaris Group recommends that the City of Fort Worth remain a member of the AMAA and MedStar. The City, through its majority on the AMAA Board of Directors, should influence the service levels and costs of service. By implementing an enhanced level of limited ALS first response of Fire Department First Response the City can leverage existing resources to augment service to the public."
Click to read the full report.
(Please note before you print, the report is 61 pages.)
Posted on Fri, July 23, 2010