Report to/Rapport
au:
Emergency and
Protective Services Committee/Comité des services de protection et d'urgence
and Council/et au
Conseil
Submitted
by/Soumis par: Steve Kanellakos, General Manager/Directeur générale Emergency
and Protective Services/Services de protection et d’urgence
Contact/Personne-ressource: Anthony Di Monte,
Director, Emergency Medical Services / Directeur,
Services médicaux
d’urgence
580-2424 ext/poste 22458,
Anthony.DiMonte@city.ottawa.on.ca
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Ref N°:ACS2002-EPS-EMS-0002 |
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SUBJECT: |
EMERGENCY MEDICAL SERVICES – certification
UPDATE |
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OBJET: |
SERVICES MÉDICAUX D’URGENCE – PERMIS MISE À
JOUR |
REPORT
RECOMMENDATION
That the
Emergency and Protective Services Committee recommend Council receive this
report for information.
RECOMMANDATIONS
DU RAPPORT
Que le
Comité des services de protection et d’urgence prenne connaissance des
renseignements contenus dans le présent rapport.
In December 2001, The
Emergency Medical Services (EMS) Branch received certification from the
Ministry of Health and Long Term Care (the Ministry) as required by the Ontario
Ambulance Act. EMS received a 91%
score on the service review; an unprecedented accomplishment for an initial
certification review of a large service.
The award of three-year certification from the Ministry is a significant
milestone for Ottawa EMS. The
following outlines the process and outcomes of the certification review
process.
The Ministry Ambulance
Service Review program was originally developed and implemented in 1994. At that time, the review was designed as a
peer evaluation of each ambulance operator’s success in meeting the
requirements of the Ambulance Act, Regulations and Standards when providing
ambulance services. The review utilized
a peer evaluation model comprised of experienced EMS service providers
(paramedics and managers) to assess the services’ performance and make
recommendations for improvement.
Following the 1997
announcement by the Government of Ontario that land ambulance services would
become the jurisdiction of upper tier municipalities, the Ambulance Act was
amended to reflect the renewed responsibility of the Ministry to monitor and
ensure compliance with the legislation and standards, including:
· Ambulance Act and
Regulations
· Land Ambulance
Certification Standards
· Ambulance Service
Patient Care and Transportation Standards
· Ambulance Service
Documentation Standards
· Ambulance Service
Communicable Disease Standards
· Provincial
Equipment Standards for Ontario Ambulance Services,
· Provincial
Vehicle Standards for Ontario Ambulance Services, and
· Other legislation
that impacts on the provision of ambulance service, such as the Highway Traffic
Act, Coroner’s Act, Mental Health Act, Substitute decision Maker’s Act,
Occupational Health and Safety Act.
In 1998, a mandatory,
quality-based certification process replaced the traditional licensing scheme.
The focus of the Service Review is to ensure that quality of patient care
and public safety is maintained. The
review does not evaluate the financial or operational management of ambulance
services except where there is a direct link to the provision of patient care
(i.e. procurement of supplies, maintenance of patient care equipment).
A Ministry appointed review
team conducts an on-site visit with the ambulance service and utilizes a
variety of methodologies to evaluate the service, including:
1. Interviews – with
management and paramedics, and staff of receiving hospital emergency
departments, Base Hospital, and dispatch.
2. Documentation
review – patient care documents, human resource files, policies and
procedures, vehicle and equipment maintenance records, staff training records
and other relevant documents pertinent to the delivery of ambulance service are
reviewed.
3. Surveys – pre-visit
surveys are used to obtain input from paramedics, dispatch, Base Hospital,
receiving hospitals, and the Regional Office of Emergency Health Services
Branch (EHSB).
4. Ride-outs / field
observation - in order to evaluate patient care, members of the review team
conduct ride-outs with paramedics on a variety of call types. The observations of team members are recorded
and evaluated based on consistency with provincial patient care standards.
5. Observation and
examination – the team conducts hands-on examinations of facilities, vehicles,
equipment and documents.
Upon completion of the site
visit, an exit interview is conducted to provide a brief verbal overview of the
findings. This provides the operator
with an early indication of level of success in meeting the requirements of the
review.
Following the site visit,
the Review Team Leader submits a draft written summary of the observations and
findings of the review team to the Investigations, Certification &
Regulatory Compliance Group of the Emergency Health Services Branch
(EHSB). Based on this report, a
determination is made as to whether or not the ambulance service has met the
requirements of the legislation and standards.
If the ambulance service has
successfully met the requirement of the review, the Director, EHSB (certifying
authority) grants a certificate to operate for three years. If requirements are not satisfied,
certification is withheld until requirements are successfully met. A subsequent site visit is arranged to
confirm that deficiencies have been corrected.
To continue to provide
service, the ambulance service must participate in another review before the
expiration of their certificate. The
Director maintains the right to suspend or revoke the certification and request
a service review at any time during this period.
Ottawa EMS underwent a
Service Review during the last week of May 2001, five months following the
downloading of the service to the City of Ottawa.
In preparation for the
Review, an Operation Delta project team was established to continue the
preparations initiated by the land ambulance transition team. Ottawa EMS was provided with a copy of the
comprehensive “review checklist” which covered twelve service areas to be
reviewed and over 400 specific line items for which evidence was
requested. The service areas reviewed
were:
Service Area |
Sample of Review Criteria |
|
Level and type of service |
Evidence of meeting
service level commitments, number of units available |
|
Employee qualifications |
Evidence of all paramedic
certification/qualification in Human Resource files |
|
Staffing levels |
Evidence of ALS/BLS
staffing levels, ability to meet service level commitments |
|
Patient
care documentation |
Evidence of quality
assurance program for completeness and accuracy of patient care documentation |
|
Training |
Evidence of mandatory core
training, continuing medical education, skills evaluations and remediation
program |
|
Patient Care |
Observation during
ride-along that consistency patient care rendered in accordance with
provincial standards |
|
Vehicles |
Evidence that vehicles
meet provincial standard, cleanliness, preventative maintenance programs |
|
Patient Care Equipment |
Evidence that equipment
meet provincial standard, cleanliness, preventative maintenance programs |
|
Policies and Procedures |
Evidence of comprehensive
P&P, communication plan, monitoring and enforcement |
|
Operations |
Compliance with directions
of dispatch/communication officers |
|
Communication |
Evidence of good working
relationship with allied health agencies, Base Hospital Program, customer
service / complaint investigation process |
|
Facilities |
Evidence of security,
health and safety, contingency planning |
Phase One involved an
extensive review of the legislative requirements and certification standards,
and the preliminary identification of acceptable “evidence”. There was a fair amount of ambiguity at this
stage of the process, in terms of what would constitute, from the Ministry’s
perspective, acceptable evidence or proof.
Other EMS services across the province, which had previously undergone a
Service Review, were consulted.
The long list of criteria
was prioritized based on assessment of risk (i.e. mandatory compliance
requirement). Key contacts were
established within the various divisions of the EMS Branch (Operations,
Logistics, Program Development) and with corporate Centres of Expertise
(COE’s), particularly Legal Services, Fleet Services, Human Resources,
Information Technology Services, and Real Property Asset Management
(RPAM). Agreement on areas of
accountability was reached, particularly with the COE’s. Regular status meetings were held throughout
the Spring, to closely monitor progress and ongoing levels of risk.
Phase Two began in April,
when a mock certification audit was conducted with the assistance of Audit
& Consulting Services, Operation Delta Project Management Office, and EMS
staff. The mock auditors were
individuals previously uninvolved with preparations, who could therefore review
the service with an unbiased eye. This
exercise helped identify new or ongoing areas of risk, as well as areas that
continued to be ambiguous in terms of acceptable documentation / evidence. Following the mock certification, a
remediation plan was developed and implemented, and areas of significant risk
were flagged for Branch Management and Department Management.
Final preparations for the
Review Team’s site visit included a briefing of all EMS staff, and final
organization of all evidence to ensure an efficient review process.
The twelve-member Review
Team spent four days on-site with Ottawa EMS.
The actual review went very smoothly, a reflection of the preparedness,
cooperation and dedication of Ottawa EMS and COE staff. All project team members and COE contacts
attended the exit interview, both as recognition of their contributions, as
well as providing an opportunity to hear first hand any outstanding
concerns. The feedback from the
interview reinforced many of the strengths and innovative practices implemented
by Ottawa EMS including:
· Commitment to
quality assurance and quality improvement
· Strong hiring process
· Excellent
training program
· Courteous,
professional, compassionate and excellent patient care provided by paramedics
· “Pride of
ownership” reflected in fleet
· Standardization
of vehicles/equipment
· Comprehensive
policy & procedures
· Innovative single
start station
· Innovative bar
coding system for equipment tracking
Several areas for ongoing
improvement were identified, which were consistent with those already
identified by the service and represented work-in-progress:
· Completeness of
HR files
· Systematic review
of patient care documentation
· Evidence that all
paramedics had successfully completed Ministry mandatory training programs
· Variations
between vehicles equipment & supply stock and Ministry standards
Based on feedback from the
exit interview, a remediation plan was developed and implemented during the
Summer and Fall, in anticipation of the formal report from the Ministry.
The final report from the
EHSB was received during the first week of December 2001. At this time, Ottawa EMS was informed that
it had satisfactorily met the requirements and was granted a three-year
certificate (November 2001-2004). The
service received a 91% on the service review; an unprecedented accomplishment
for an initial certification review of a large service.
The final report contained
27 recommendations, eleven of which were mandatory compliance issues and were
reviewed at a subsequent visit. The
majority of the recommendations was consistent with feedback during the exit
interview, and therefore had already been resolved in the six-month period
between the actual review and the receipt of the final report. On January 25, 2002, a follow-up meeting was
held with Ministry Inspectors and the outstanding recommendations were reviewed
and evidence presented. Although there
is one final report to be received from the Ministry, feedback from this follow
up meeting indicates there are no outstanding concerns.
The award of a three-year certification from the Ministry is a
significant milestone for Ottawa EMS.
In addition to the obvious benefit, that of the Ministry’s endorsement
to provide ambulance services to the citizens of Ottawa, there are many
benefits for Ottawa EMS having undergone this certification process so early
and so successfully in the start up year.
It was a great team building exercise involving staff from across the
Branch, and the corporate Centres of Expertise. Certification served as a great impetus for accomplishing so much
in the first five months, and has set the standard for Ottawa EMS and our
corporate partners.
Ottawa EMS has resoundingly
demonstrated its ability to meet the provincial standards within its first six
months of operation. With the ongoing
development of quality assurance and quality improvement programs, the opportunity
to emerge as an EMS industry leader is clearly within reach.