BCEHS Clinical Response Model Neil Lilley Senior Provincial - PowerPoint PPT Presentation

1 BCEHS Clinical Response Model Neil Lilley Senior Provincial Executive Director Patient Care Communications & Planning February 13, 2019

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3 BCEHS Action Plan The BCEHS Action Plan was developed to ensure the right care is provided with the right resource to the right patient at the right time. The plan calls for: • Adjustments to our clinical responses – not all patients need to go to ED; • Implementation of strategies that better match our service when and where our patients need us; and • The development of opportunities for sustainable careers

4 Clinical Response Model and the Action Plan Additional Resources Clinical Community Response Paramedicine Model 2020 Action Plan HealthLink BC Future & Secondary Initiatives Triage

5 Background • BCEHS can utilize alternative clinical responses to ▫ Provide the most appropriate care for each patient ▫ Ensure timely care for high acuity patients ▫ Provide alternative care options for low acuity patients ▫ Relieve pressure on emergency departments and BCEHS by reducing transports to hospital • Ministerial Orders M146 and M147 extend the mandate of BCEHS under the Emergency Health Services Act to conduct secondary triage and to develop protocols for treatment at scene or transport to a non-ED destination • Need to build a foundation and baseline before launching new protocols ▫ Standardized approach for call prioritization and decisions on alternative care ▫ Coordinated approach to introducing protocols (alternative destination, alternative transport, treat & refer)

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7 2013 Resource Allocation Plan • Previous allocation system used three levels • Highest Level Available of prioritization. CRM allows for six • Code 3 (lights and sirens) • Highest priority events HLA -3 • Diversions can only be made from Code 2 to Code 3 events • Basic Life Support • • Code 3 (lights and sirens) No capability to support low acuity • Medium priority BLS-3 pathways (Secondary Triage, Treat and Refer, etc.) • • Basic Life Support Focus is on response times, less of a clinical • Code 2 (routine) focus • Low priority BLS-2

8 Clinical Response Model – Initial Rollout

9 Clinical Response Model – Descriptions

10 High Acuity Events Purple Red • Highest level of acuity • Immediately life threatening or time-critical • Immediately life threatening • Divert from Red to Purple • Takes precedence over all other • Response: HLA Code 3 events • Response: HLA Code 3 • Mostly Deltas and Echos • MPDS Codes: Deltas & Echos • Example: 19D04 Heart Problems / A.C.I.D. – Clammy or cold sweats • Example: 09E02 Cardiac Arrest – UNCERTAIN BREATHING

11 Mid-Low Acuity Events Orange • Urgent / potentially serious but • Non-urgent (not serious or life not immediately life threatening threatening) • Divert from Orange to Red or • Divert from Yellow to Orange, Red Purple or Purple • Response: PCP / EMR Code 3 • Response: PCP / EMR Code 2 • Example: 23C02c Stroke (CVA/TIA) • Example: 02A10 Sick Person – – Abnormal breathing – PARTIAL Unwell/Ill evidence stroke < 6 hrs

12 Low Acuity Events Blue Green • Non-urgent (not serious or life • Non-urgent (not serious or life threatening) threatening). Further telephone triage appropriate • Used for scheduled Community • Response: HealthLink BC Paramedic visits • Future Uses: • Example: 18O01 Headache – Breathing normally with 1st party • Low acuity patients in need of verification advanced skills • Will be re-coded if an ambulance • Assess, See, Treat & Refer response is required capabilities

13 Clinical Response Model Objectives 1. Align with global practice to shift from a time-based response model to a clinically based model 2. Ensure the highest acuity patients are better prioritized 3. Build the foundation for future changes to low acuity responses 4. Align requests for First Responders and Fire Agencies to provide patients with the most appropriate care and utilize resources effectively

14 Foundations for Improvements in Care Mental Health Referrals to Other Alternative Alternative Virtual Care Palliative Care Services Health Providers Transport Destination Assess, See, Treat, Refer Alternative Care Pathways Secondary Triage Prioritization Reviews Clinical Response Model Colours o The Clinical Response Model is the foundation for organizational improvements and required changes to clinical responses • This enables future initiatives for alternative types of care (other than treat and transport) which will become Blue and Green responses

15 BCEHS Event Volumes 911 Events with • Highest acuity (Red & Purple) events Ambulance Response make up 27% of events with an ambulance response 2% • Code 3 (lights and sirens) response for 25% Purple Events 56% of all pre-hospital events 44% Red Events Orange Events • Low acuity Yellow events (44%) make Yellow Events up the highest volumes 29%

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17 What this means for First Responders First Responders play a critical role in responding to our most urgent calls, and their quick arrival can mean the difference between life and death. The Clinical Response Model provides the following benefits for First Responders: ▫ Less time on scene for FRs ▫ Fewer calls FRs will need to attend and wait for an ambulance to be freed up ▫ More effective use of municipal and provincial resources, with time freed up to address other responsibilities ▫ Improved patients/residents experience and outcomes ▫ Reduction in call volume related to low acuity events

18 Criteria for Requests for Fire FRs • Co-response with the Clinical Response Model is focused on high acuity time critical calls • BCEHS will request First Responders for all calls that meet any of the following criteria: o Any call triaged as a Purple or Red event o Any Orange calls where ambulance response is likely to take >10 minutes to arrive o Any call involving a motor vehicle accident, hazmat, drowning / near drowning or fire o Any other call with a clinical or operational need for First Responder expertise, such as an environmental or safety risk, or in the case where the Paramedic Crew requests First Responder backup

19 Types of responses for Fire FRs Response Type: Co-Response First Response Tactical Support Clinical Response FR appropriate Orange Calls Purple and Red Any Model Call Type: (as per 2013 RAP review) Fire will be requested to Fire will be requested to Fire will be requested when a all Purple and Red calls Orange calls to provide crew or dispatcher identifies Description: to provide medical medical attention when that an event requires fire support in addition to BCEHS is expected to take services support for tactical BCEHS resources 10 mins or longer to arrive reasons Automatic through InterCAD Automatic through Method of Manually send via InterCAD or by phone for MPDS codes InterCAD or by phone if Notification: or phone if n/a 7, 8, 14, 15 and 29. By phone n/a for any other code

20 Why the 10 minutes? 1. BCEHS response times are from time of call received from 911 through to the time BCEHS resource on scene 2. Before FR receives an event there is an average of 3 mins of call processing time at BCEHS 3. FR response time is from time they received the call from BCEHS to time FR arrived on scene (avg 7mins as per ORH report) 4. Average FR response in total would equate to 10 mins 5. Reduces unnecessary double dispatching of resources when not required and ensures resources are available for high acuity calls when they present to BCEHS

21 Why the change in response for Fire FRs? BCEHS is changing the way in which it dispatches all resources and not just FR responses. This is to ensure that resources are more readily available for those events where time is critical. How?: • Reduce the number of resources being dispatched to low acuity calls • Reduce sending any resources to the lowest acuity calls that do not need a response and alternative treatment is best for the patient • Reduction in responses for BCEHS and FR • Increased availability for most critical calls

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Situation: Pre-CRM Friday night at 8:00 pm Friday night at 8:10 pm MPDS 10C02 – Chest pain/Chest MPDS 9E01 – Suspected discomfort/cocaine workable arrest/Not breathing

Situation: Post-CRM Friday night at 8:00 pm Friday night at 8:10 pm MPDS 10C02 – Chest pain/Chest MPDS 9E01 – Suspected discomfort/cocaine workable arrest/Not breathing

25 What does medical evidence tell us?

26 Why use evidence based medicine? • Evidence based medicine (EBM) is an approach to medical practice intended to optimize decision making by emphasizing the use of evidence from well-designed and well-conducted research. • EBM advocates that to the greatest extent possible, decisions and policies should be based on evidence, not just the beliefs of practitioners, experts, or administrators