Finding 1: Police Dispatch Time and Fire Turnout Time for EMS Could Be Improved

Transcription

1 Office of the City Manager To: From: Honorable Mayor and Members of the City Council Phil Kamlarz, City Manager Submitted by: Debra Pryor, Fire Chief Subject: Audit: Response Times to Calls for EMS Could Be Improved SUMMARY The Auditor s Office presented the Audit: Response Times to Calls for EMS Could Be Improved report to City Council on June 24, The purpose of the audit was to determine if the City is timely responding to requests for emergency medical services. The audit report contained twelve (12) recommendations, and asked that a status report on these recommendations be made to Council in December At this time, nine (9) of the 12 recommendations have been implemented, and 3 are partially implemented. CURRENT SITUATION AND ITS EFFECTS The 6/24/08 audit reported that the new computer aided dispatch (CAD) system was expected to be operational by the end of December Due to delays, transition to the new CAD system actually occurred on 4/28/09. The delay alters the length of time the department has been taking advantage of the system s improved ability to report on dispatch and turnout times. The Fire Department continues to work collaboratively with the Police Department and the Department of Information Technology on several of these recommendations. The next 12 months of hands-on operation and data should provide for more comprehensive reporting. Since there will be no new updates for at least another 12 months, the next report to Council on the status of partially implemented recommendations will be by December Finding 1: Police Dispatch Time and Fire Turnout Time for EMS Could Be Improved Recommendation for Police 1.1 Once the new Public Safety technology system is in operation, but within one year s time, Police should routinely examine EMS events that took significantly longer than 1 minute (or other reasonable performance measure) to dispatch, and identify areas 2180 Milvia Street, Berkeley, CA Tel: (510) TDD: (510) Fax: (510) manager@cityofberkeley.info Website:

2 where dispatch time can be shortened. Update written policies and procedures to correct problems found. Consider hiring a consultant to perform this analysis and make recommendations for improvement. Status: Implemented. Dispatch times have improved since implementation and will continue to be routinely examined. Expanded capability of the new system has lessened the need for a consultant. Written policies and procedures have been updated. 1.2 Once the new Public Safety technology system is in operation, but within one year s time, Fire should routinely examine EMS events that took significantly longer than 1 minute (or other reasonable performance measure) for turnout, and identify areas where turnout time can be shortened. Update written policies and procedures to correct problems found. Consider hiring a consultant to perform the analysis and make recommendations for improvement. Status: Implemented. Fire is routinely examining EMS turnout time that is significantly longer than the established performance measure and updating policies and procedures when ways to shorten turnout time are identified. Finding 2: Majority of Fire Department Emergency Responders Reported Dissatisfaction with Dispatch Services and Support for Establishing an EMD Program Recommendation for Police and Fire 2.1 Fire and Police should jointly identify outside training, or develop adequate training internally, to allow Berkeley call takers and dispatchers to more effectively meet the needs of Fire personnel, as well as Police field staff. To determine these needs consider periodically performing a customer service survey of fire staff and police patrol staff. Status: Implemented. Fire and Police have jointly increased efforts to provide call takers and dispatchers with training designed to help them more effectively meet the needs of Fire personnel and Police field staff. Customer service surveys will be conducted periodically. Recommendation for Police and Fire 2.2 Once the new Public Safety technology system is in operation, but within 18 months, prepare a cost-benefit analysis to determine if the City should establish an emergency medical dispatch (EMD) program. Status: Partially Implemented. Police and Fire are in contact with Alameda County to determine operational feasibility. Information has been requested and will be researched and analyzed. Page 2

3 Finding 3: Inconsistent Criteria Was Used to Determine When to Record Some EMS Response Times Recommendations for Police 3. Once the new Public Safety technology system is in operation, but within one year s time, update PSAP written policies and procedures, and the training manual, to include the specific criteria as to when dispatch time and en-route time are to be recorded in CAD. Status: Implemented. Written policies and procedures, and the training manual, have been updated to include criteria on dispatch and en-route times. Finding 4: EMS Response Times for Non-City Owned Ambulances Were Often Not Timely 4.1 Determine whether anything can be done to reduce response times for calls handled by non-berkeley ambulances. Provide this information to City Council with the Fire Department s recommendations for corrective action, if any. Status: Implemented. The Fire Department has no authority over non-berkeley ambulances. Discussions were held with Alameda County and American Medical Response (AMR) to determine whether anything can be done to reduce response times for calls handled by non-berkeley ambulances. Non-Berkeley ambulances have to travel greater distances and are contractually obligated to meet response times in their assigned jurisdictions. AMR continues to handle calls as expeditiously as possible. 4.2 Even if there is no opportunity to improve response times for calls handled by non- Berkeley ambulances, clearly identify in reports to Council the response times attributed to non-berkeley ambulances versus times attributed to Berkeley s EMS first responders. Status: Implemented. Response time data reports are routinely generated and compared to Berkeley s EMS first responders. Finding 5: Performance Measures Fell Short of a Patient-focused Approach 5.1 Once the new Public Safety technology system is in place, but within 12 months, consider establishing and reporting on performance measures that are more patient focused. Each segment of time: call handling, dispatch, turnout, travel, on-scene, and patient contact should be measured as part of total response time. Each Page 3

4 segment should be monitored to identify areas for improvement. If changes in technology allow, begin reporting on the time the call is placed. Status: Implemented, except for ring time and patient contact. The segments of response time have a performance measure which is periodically compared with actual time to identify areas for improvement. It was noted during the audit that the new CAD system would not be able to track ring time. Also, current portable communication equipment does not log patient contact. However, if reliable technology is available in the future, the Fire and Police departments will consider these segments for performance monitoring. 5.2 Since the delay in ring time at the Berkeley PSAP can be several minutes when an emergency call is initially received at a location other than the Berkeley PSAP, continue community outreach efforts to inform the public of the importance of directly dialing (510) from cell phones in case of emergency. Status: Implemented. Since the current City telephone system became operational over eight years ago, the Police Department has continued to emphasize the use of as an emergency number for cell phone users. This number is used in community outreach, on both the Police and Fire Departments web site, and in other Police publications. Improvement in technology has allowed Berkeley Dispatch Center to accept 911 calls directly from cell phones. Finding 6: Reports Needed to Effectively Monitor EMS Response Time Were Not Available and Police 6.1 Establish performance measures for elapsed dispatch time, elapsed turnout time, etc. (using the fractile method) that sufficiently challenge dispatchers and EMS responders to perform their duties as quickly and efficiently as is practical. Status: Implemented. Elapsed time performance measures using the fractile method have been established for each segment of response time. These performance measures challenge the dispatchers and EMS responders to perform their duties as quickly and efficiently as practical. Recommendations for Fire, Police, and Information Technology 6.2 During implementation of the new system, work with the vendor to ensure that reports are designed to enable implementation of our recommendations for better monitoring and improved patient-focused information. Produce reports that permit the Fire Department to effectively monitor EMS response time, including first unit to arrive on-scene time, dispatch time, and turnout time. Actual performance should routinely be compared with established performance measures and industry Page 4

5 standards. Reports should also permit the Fire Department to effectively monitor compliance with the County of Alameda ambulance provider contract and to quickly identify and correct areas of contract non-compliance. Status: Partially Implemented. Reports that monitor EMS response time are produced, compiled, and monitored on a periodic basis, and will be compared with established performance measures, industry standards, and contract requirements., Police, and Information Technology 6.3 Track patient outcomes for patients with a specific condition in which a successful outcome relies on a quick EMS response time, such as patients with cardiac arrest. Use data gathered to evaluate performance and to consider new procedures which could improve patient outcome. Status: Partially Implemented. The new CAD system cannot track patient outcome. Consideration must be taken with regards to privacy regulations under the Health Insurance Portability and Accountability Act (HIPAA). Fire is researching whether or not other jurisdictions can obtain patient information and still comply with HIPAA. BACKGROUND As part of the City s Standard Audit Procedures, several performance audits were conducted at the Berkeley Fire Department. In addition to this audit, the Auditor audited four (4) other areas, all which were completed and reported to the Council as follows: Lost Time and Overtime (September 16, 2008), Ambulance Billing (September 16, 2008), Emergency Medical Personal Protective Equipment (March 25, 2008), and Controlled Substances (September 16, 2008). This is the last audit to be reported. POSSIBLE FUTURE ACTION The Departments of Police, Fire, and Information Technology continue to work collaboratively on the new CAD system s operational features. Functional operation and capabilities of the new system will be monitored over the next 12 months. The next report to Council on the status of partially implemented recommendations will be by December FISCAL IMPACTS OF POSSIBLE FUTURE ACTION Any possible future action could fiscally impact dispatcher training and overtime by approximately $36,000 per year in recurring training, overtime, and backfill costs. This amount is currently not budgeted. CONTACT PERSON Debra Pryor, Fire Chief (510) Page 5

6