City of El Paso Department of Public Health

City of El Paso Department of Public Health

DSRIP Project: Automated Emergency Dispatch System

Identifying Project and Provider Information:

Title of Project: Automated Emergency Dispatch System

RHP Project Identification #: 065086301.1.4

Project Option: 1.10.2 Enhance Improvement Capacity through Technology

Performing Provider Name: City of El Paso Department of Public Health/065086301

Project Description:

The City of El Paso Department of Public Health proposes to expand quality improvement through technology so that resources can enhance performance, improvement, and reporting capacity of the 911 radio dispatch system by upgrading to an automated dispatch system.

The City of El Paso is currently using a manual, analog 800 MHZ trunked dispatching radio system. At present time, the system requires 9 to 11 call takers to process phone calls. Information is electronically uploaded to the fire dispatcher with assistance from the Computer Aided Dispatch system (CAD). The dispatcher is then required to verify incident, recommend units, location availability of units and dispatch over a single talk group. The talk group is a single channel with two way information traffic. The talk group is used for dispatching units to incidents, communication between dispatch and units while en route to incidents, communication with units out of station not responding to incidents and mobile units. During multiple incidents and receiving 911 calls, dispatch experiences a back log of dispatches (stacked calls). This is due to having to communicate with each unit independently. These combined actions increase the extended time of dispatching emergency apparatus to an incident creating longer response times.

To improve CountyPublic health, the City of El Paso Department of Public Health is proposing to enhance dispatch performance (Project 1.10 Enhance Performance Improvement and Reporting Capacity) and reporting to decrease dispatch times. This will ensure the public receives prompt Emergency Medical Care for the region. Once the dispatch system is installed and operational, an assessment will be completed to establish new baseline response times. These new response times will allow for improvements to be tracked and result in a positive patient outcome.

Goals and relationships to regional Goals

The goal of this project is improve prompt Emergency health care response to the El Paso area while providing accurate real time location data. This result of an automated dispatch system will decrease response times from the time the public calls 911 to arrival of an emergency vehicle to the scene. The reduction of time to the scene on an emergency will increase survivability rates as well quality of life for the region. Data will be obtained through the system to analyze and share information to meet and improve the quality of emergency care.

Project Goals:

• Conduct training requirements with the new system to 911 dispatchers and field emergency personnel.
• Introduce the automated system to the existing CAD system with software updates at the 911 dispatch center.
• Enhance communications through software upgrades to responding emergency vehicles and stations.
• Conduct research on response times with comparison to manual analog system.
• Analyze emergency call data and health information data by catchment area of emergency response station to differentiate staff skill sets/training requirements by needs of service population
• Show reduction in response times from time of call to arrival on the scene.
• Show increased survivability rates and quality of life issues after an emergency event.

This project meets the following regional goals:

The Automated Dispatch project will enhance regional capacity to respond to health related medical emergencies.

• Provide the full continuum of healthcare services, from wellness to preventative care to disease management, to emergent, to palliative and hospice care.

Challenges :

Challenges that may occur will happen during the transition phase between the two systems. The areas include training with the 911 system and the timing of installation changes in software from the current system to the automated system. The changes will occur at the dispatch center, vehicles and stations and can possibly cause disruption on current 911 dispatching. Challenges in the future will be to insure a quicker response time with education to the community on the recognition of a medical emergency. This challenge can be crucial with the change in the community in regards to an increasing elderly category of “baby boomers”.

5 Year Expected Outcome for Provider and Patients:

Within the 5 year work period the region will see a commitment to improved response time; enhanced emergency medical care system; improved survival rates and a quality of life after release from an area hospital. The information gathered will determine trends within the region and specific areas that will help responders to insure the best care possible. The collected data will also allow better training in the field directly related to regional health issues that will have been diagnosed. The statistical information will help in continuing education to the region on the importance of recognizing true emergencies and health issues.

Starting Point Baseline:

Current existing dispatch average time (Dispatch call handling 3:27 min., Turn out time 1:42min., 1st unit arrival travel to scene 7:04min. and a total time response 13:24min.)

Rationale:

When calling 911 for a medical emergency or any other emergency, a quick response is expected. Emergency Medical Care response in the El Paso region currently occurs at 7.04 minutes. Studies show that the chances of survival are reduced 7%-10% with every minute that passes without ALS intervention.

There are many areas of concern in the public health community, Cardiac arrest being one of them. In medical emergencies, sudden cardiac arrest patients may become irreversible if ALS intervention is not implemented early. According to Ludwig (2004), The American Heart Association’s scientific position, is that brain death and permanent death start to occur in 4-6 minutes after someone experiences cardiac arrest. The window of opportunity for the chance of survival with no neurological deficits to the patient decreases the later care arrives.

The El Paso region has many health related challenges: diabetes, obesity due to poor nutrition, decreased daily exercise and a large elderly population that significantly increases cardiac emergencies in the community. Most 911 calls pertaining to patients with chest pain, without prompt care, can lead to a cardiac arrest situation. These patients require a rapid dispatch and transport to the hospital to restore blood and oxygen to the heart. Other medical emergencies where time is an issue is those with signs and symptoms of an acute stroke, respiratory disease and trauma patients that require a Level I trauma hospital.

Through this DSRIP initiative (Project option 1.10.2) the health department is proposing to enhance the 911 dispatch system to the El Paso region. This technology has been noted to reduce dispatch times by 35-37 seconds. With the help of the computer aided dispatch (CAD) system and Pro Q A, times from caller to arrival shall decrease. This will affect patient’s survivability, and quality of life. This initiative will include direct improvement to the automated dispatch system as well as to reducing dispatching times.

The initiative will include a roll out plan to stations and apparatus in the region; hardware and software will also be included in the upgrade policy. The plan will include measures and targets for new response times as well and including process improvement possibilities that will work in conjunction with the new automated dispatch system.

Project components

• Provide training and education to clinical and administrative staff on process improvement strategies, methodologies, and culture.
• Develop an employee suggestion system that allows for the identification of issues that impact the work environment, patient care, and satisfaction.
• Design data collection systems to collect real-time data that is used to drive continuous quality improvement.

Unique Community need identification numbers the project addresses

CN.1 Primary Care

CN.2 Secondary/Specialty Care

CN.6 Other community need as identified by the performing provider

How the project represents a new initiative or significantly enhances an existing delivery system reform initiative

The automated dispatch system enhances the present system, by decreasing response times with the use of an automated voice system while the dispatcher communicates with the caller. The present system requires the dispatcher to stop communicating with the caller in order to dispatch the call to the station. With the use of the new system, the dispatcher has the ability to handle a

higher call volume without added staff and experiences a reduction in stacking of calls. The project will provide the community with a higher percentage of positive outcomes for those needing emergency care. The system will help in the analysis of response times and identifying areas with current health related challenges the El Paso region possesses.

Related Category 3 Outcome Measure(s):

Outcome Domains (OD-10): Quality of Life/ Functional Status

Improvement Targets IT-10. 7 (DY 4-5): Other Outcome Improvement Target (TBD)

Reason/Rationale for selecting the outcomes measures:

Selecting outcome improvement targets allows the department the flexibility of focusing on what is important for the community. The outcome of the proposed DSRIP is to reduce response times to the region for emergency response care. Specific targets will be established as an assessment is performed after the system is fully operational and all locations have been upgraded.

Relationship to Other Projects:

The El Paso Fire Department complements other Health department DSRIP submissions: El Paso Community Health Atlas (065086301.1.2), which seeks to develop a comprehensive biomarker database which can be analyzed by zip code or other geo, demographic, or health-related criteria for research and targeted interventions to address health disparities in the border region and the Border Public Health Interest Group (065086301.1.1) which seeks to collect and analyze REAL data for identification and reduction of disparities related to race, ethnicity and language. The El Paso Fire Department can supplement data acquired through the biomarker program by dissemination of medical disposition cluster analysis through the TRIPTIX reporting system. This system evaluates trends in response, monitors types of medical issues and partners with bio watch to help identify biohazards.

Relationship to Other Performing Providers’ Projects in the RHP

The El Paso Fire Department also complements other DSRIP initiatives in Region 15 including:

• UMC: Enhance Performance Improvement and Reporting Capacity at UMC Neighborhood Health Centers
• UMC: Chronic Care Model for Neighborhood Health Centers
• Texas Tech: Disease Management Registry
• Tenet: Enhance Interpretation Services and Culturally Competent Care
• HCA: Chronic Disease Management Registry

Plan for Learning Collaborative:

Performing Providers, IGT entities, and the Anchor for Region 15 have held consistent monthly meetings throughout the development of the delivery system for the low-income Waiver. As noted by HHSC and CMS, meeting and discussing Waiver successes and challenges facilitates open communication and collaboration among the Region 15 participants. Meetings, calls, and webinars represent a way to share ideas, experiences, and work together to solve regional healthcare delivery issues and continue to work to address Region 15’s community needs. UMC, as the Region 15 Anchor anticipates continuing to facilitate a monthly meeting, and potentially breaking into workgroup Learning Collaboratives that meet more frequently to address specific DSRIP project areas that are common to Region 15, as determined to be necessary by the Performing Providers and IGT entities. UMC will continue to maintain the Region 15 website, which has updated information from HHSC, regional projects listed by Performing Provider, contact information for each participant, and minutes, notes and slides from each meeting for those parties that were unable to attend in-person.

Region 15 participants look forward to the opportunity to gather annually with Performing Providers and IGT entities state-wide to share its experiences and challenges in implementing its DSRIP projects, but also recognizes the importance of continuing ongoing regional interactions to effectuate change locally. Through the use of both state-wide and regional Learning Collaborative components, Region 15 is confident that it will be successful in improving the local healthcare and indigent population.

Project Valuation:

The value to the community of the Automated Emergency Dispatch System DSRIP project over the course of the funding period is $7,445,616. Of that amount $5,793,499 has been allocated for Category 1 Infrastructure Development. The valuation takes into account a complete upgrade of the dispatch system that includes: a new voice automated system, CAD interface, software and hardware systems, audio licenses, training and configuration, station dispatch equipment, and warranty. The proposed project also takes into account the efficiencies of response times and the possible reduction of health costs in the region. While the reduction in costs for healthcare is conservative, only a fully operational automated dispatch system in the region will be able to determine the true savings in health care cost.

065086301.1.4 / 1.10.2 / 1.10.2 (Quality Improvement) / Project Title: Automated Emergency dispatch system
Performing Provider Name: City of El Paso Department of Public Health / TPI: 065086301
Related Category 3 Outcome Measures: OD-10 Quality of Life/ Functional Status / 065086301.3.4 / IT-10.7 / Other Outcome Improvement Target (TBD)
Year 2
(10/1/2012 – 9/30/2013) / Year 3
(10/1/2013 – 9/30/2014) / Year 4
(10/1/2014 – 9/30/2015) / Year 5
(10/1/2015 – 9/30/2016)
Process Milestone
P-5
Enhance or expand the organizational infrastructure and resources to store, analyze, and share the patient experience data and/ or quality measures data, as well as utilize them for quality improvement
Process Metric
P-5.1
Increased collection of patient experience and/ or quality measures data
Goal: Implement automated dispatch system. Monitor unit deployment trends, e.g., triaging of calls, response times. Report findings and adjust staffing and response protocols, as needed.
Data Source: Performance monitoring/tracking data system
Estimated incentive payment:
$746,750
Process Milestone
P-9
Participate in face-to-face learning at least twice per year with other providers and RHP to promote collaborative learning around shared or similar projects. At each face-to-face meeting, all providers should identify and agree upon several improvements (simple initiatives that all providers can do to “raise the floor” for performance). Each participating provider should publically commit to improvements
Process Metric
P-9.2
Implement the “raise the floor” improvement initiatives established at the semiannual meeting
Goal: Participate in face-to-face learning
Data Source: Documentation of semi-annual face-to-face meetings; evidence of “raise the floor” initiative
Estimated Incentive Payment:
$746,750 / Process Milestone
P-5
Enhance or expand the organizational infrastructure and resources to store, analyze, and share the patient experience data and/ or quality measures data, as well as utilize them for quality improvement
Process Metric
P-5.1
Increased collection of patient experience and/ or quality measures data
Goal: Implement automated dispatch system. Monitor unit deployment trends, e.g., triaging of calls, response times. Report findings and adjust staffing and response protocols, as needed.
Data Source: Performance monitoring/tracking data system
Estimated incentive payment:
$700,027
Process Milestone
P-9
Participate in face-to-face learning at least twice per year with other providers and RHP to promote collaborative learning around shared or similar projects. At each face-to-face meeting, all providers should identify and agree upon several improvements (simple initiatives that all providers can do to “raise the floor” for performance). Each participating provider should publically commit to improvements
Process Metric
P-9.2
Implement the “raise the floor” improvement initiatives established at the semiannual meeting
Goal: Participate in face-to-face learning
Data Source: Documentation of semi-annual face-to-face meetings; evidence of “raise the floor” initiative
Estimated Incentive Payment:
$700,026 / Improvement Milestone
I-9
Demonstrated improvement in 2 selected quality measures
Improvement Metric
I-9.1
Improvement in selected quality measures
Goal: Develop/implement quality improvement data system with benchmarks for appropriate triaging of emergent calls and response time expectations. Collect and report patient experience data; adjust operations, accordingly
Data Source: Performance monitoring/tracking data system; evidence of evaluative/reactive response to patient experience data system
Estimated Incentive Payment:
$749,982
Process Milestone
P-9
Participate in face-to-face learning at least twice per year with other providers and RHP to promote collaborative learning around shared or similar projects. At each face-to-face meeting, all providers should identify and agree upon several improvements (simple initiatives that all providers can do to “raise the floor” for performance). Each participating provider should publically commit to improvements
Process Metric
P-9.2
Implement the “raise the floor” improvement initiatives established at the semiannual meeting
Goal: Participate in face-to-face learning
Data Source: Documentation of semi-annual face-to-face meetings; evidence of “raise the floor” initiative
Estimated Incentive Payment:
$749,981 / Improvement Milestone
I-9
Demonstrated improvement in 2 selected quality measures
Improvement Metric
I-9.1
Improvement in selected quality measures
Goal: Develop/implement quality improvement data system with benchmarks for appropriate triaging of emergent calls and response time expectations. Collect and report patient experience data; adjust operations, accordingly
Data Source: Performance monitoring/tracking data system; evidence of evaluative/reactive response to patient experience data system
Estimated Incentive Payment:
$699,992
Process Milestone
P-9
Participate in face-to-face learning at least twice per year with other providers and RHP to promote collaborative learning around shared or similar projects. At each face-to-face meeting, all providers should identify and agree upon several improvements (simple initiatives that all providers can do to “raise the floor” for performance). Each participating provider should publically commit to improvements
Process Metric
P-9.2
Implement the “raise the floor” improvement initiatives established at the semiannual meeting
Goal: Participate in face-to-face learning
Data Source: Documentation of semi-annual face-to-face meetings; evidence of “raise the floor” initiative
Estimated Incentive Payment:
$699,991
Year 2 Estimated Milestone Bundle Amount: $1,493,500 / Year 3 Estimated Milestone Bundle Amount: $1,400,053 / Year 4 Estimated Milestone Bundle Amount: $1,499,963 / Year 5 Estimated Milestone Bundle Amount: $1,399,983
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD (add milestone bundle amounts over Years 2-5):$5,793,499

City of El Paso Department of Public Health