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Audit: EMS personnel report high fatigue rate

Thursday, September 26, 2013 by Michael Kanin

An audit performed by the City Auditor’s Office suggests that Austin-Travis County Emergency Medical Service rank-and-file employees are overly fatigued. The document also hints that a policy of allowing patients to decide which hospital they are delivered to adds to employee fatigue – and costs taxpayers extra dollars.


Auditor Ken Mory’s team presented the findings to Council members at the regular Audit and Finance Committee meeting Wednesday. There, Council members picked up on the expenses associated with longer ambulance trips.


Council Member Bill Spelman extracted the fact that taxpayers pay for about 20 percent of the extra cost to EMS of driving patients to relatively distant hospitals of their choice. Spelman then added to that observation.


“In addition, it’s also costing the public in another way in that the public now does not have access to that ambulance during the period when the transport is taking place,” he said. “So, if there is another emergency, we’re going to have to move different ambulances around.”


EMS officials later noted that such movement contributes to medic fatigue.


System Medical Director Paul Hinchey was reluctant to change the current policy. In a letter written directly to Council’s Audit and Finance Committee, Hinchy remained committed to patient service selection. “Limiting access (via restricting hospital choice)…may interfere with continuity of established care relationships, which can result in delayed diagnosis, increased testing, unwarranted admission, the need for transfer to another facility and difficulty obtaining follow-up care,” Hinchey wrote.


In all, the audit reports five major findings: That area medics provide “quality patient care according to a survey of local medical professionals”; that the system does not have a long-term strategic plan in place that would, at least in part, deal with rapid regional growth; that “medics have experienced increased fatigue that impacts the quality of their work”; that Hinchey has not established restrictions for “low-priority transports” – the issue that patients can pick a hospital – and that no guidelines exist for the “formal review of low-priority/high-frequency incidents.”


In the audit, Mory’s team found that nearly 90 percent of the service’s rank-and-file paramedics that responded to a fatigue survey report often experiencing fatigue. Roughly 60 percent of respondents said that the issue is “more common now than one year ago; about half said that their fatigue “impacts quality of their work.”


By contrast, EMS management reported far less fatigue and a lower impact of the issue on the effectiveness of their work. Fewer than 10 percent of employees that responded to the Auditor’s survey said that they “have adequate opportunities to provide feedback on fatigue.”


The audit offered four recommendations for EMS management: That the service develop a long-term strategic plan to deal with population growth and other issues; that it deal with its employee fatigue issues; that the service review its policy of allowing patients to select the hospital to which they are transported; and that it figure out a way to look at low-priority/high-frequency issues, including an assessment of patient care delivered in those situations.


Management concurred with the findings. EMS Chief Ernie Rodriguez told Council members that the department had already begun cobbling together a more focused long-term plan, and that it would address the fatigue issues.


For his part, Hinchey continued to push back against the idea that patients should not always dictate which hospital they go to. “I can’t project what I necessarily think is the best place for you to be because so many the things go into that decision are so multi-faceted and so personal – what we absolutely don’t want to be is an obstacle to access to healthcare,” Hinchey told Council members Wednesday.


Spelman suggested that there could be a middle ground between Hincheys clear reluctance to change the policy, and the costs of current practice. “Since I don’t have an emergency right now, from my point of view this is an insurance decision – I’m buying an insurance policy that is associated with our EMS department, and our taxes,” Spelman said, taking the point of view of taxpayers not immediately in the back of an ambulance.


“I’m expecting a certain level of service. I might be interested in paying a little bit more for the gold level of service associated with being able to go to the hospital of my choice,” he said. “I might, however, be willing to accept a silver level of service which gets me to the hospital in my system that is closest to the incident itself.”


Mory’s audit comes in the wake of other audits critical of EMS practices, a study that suggests the service may not be beyond repair, but is in need of some change, and pressure from the city’s Public Safety Commission to fold EMS service into Austin’s Fire Department.

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