Louis Gonzales: grabby meredith will be on soon and things off is Dr brace on.
Louis Gonzales: There you are sorry Jane I didn't see it.
Meredith Rodriguez: Okay we'll just give them all around a few more minutes to get over here and get started and sorry Lucy already said that.
yeah.
Louis Gonzales: meredith while we're waiting here.
Louis Gonzales: The State partnership manager me previously.
Meredith Rodriguez: Well, as.
Louis Gonzales: The State partnership managers, did they meet attractive me previously.
Meredith Rodriguez: No, no, that was just.
Meredith Rodriguez: Last month, because of the veterans day holiday, they should they're meeting right now.
Louis Gonzales: Okay, can you send me that link after we had started.
Louis Gonzales: yeah theory.
Meredith Rodriguez: Coming up in the chat is the link so.
Meredith Rodriguez: Okay.
Meredith Rodriguez: canada's have slowed down a little bit, so we can go ahead and get started.
Meredith Rodriguez: We have really two fabulous speakers today i'm going to tag team it a little bit The first one is Dr Jane brace she is the Chair emergency medicine at unc Chapel Chapel hill.
Meredith Rodriguez: has extensive experience as an Ms medical director emergency medicine professor and Ms position.
Meredith Rodriguez: She works at the Durham county Ms for 10 years and the Carolina air care for five years, she also founded the unc Ms fellowship for physicians seeking advanced training and the Ms.
Meredith Rodriguez: she's a debbie, the editor for pre hospital emergency care internal she's also the API for our emc targeted issue specifically work is focused on working with the Ms pets in North Carolina.
Meredith Rodriguez: This is going to talk a little bit about that program and today it's really focused on providing tools and training resources in this philly kind of robust online system to increase performance.
Meredith Rodriguez: And co presenting with her is robbing Milton the Pec a participant in the north Carolina program he's decided at the Burke county Ms and has worked with Robert Kennedy Ms for 14 years he's critical care certified.
Meredith Rodriguez: And also works with in North Carolina office bms as a level two paramedic instructor.
Meredith Rodriguez: And with that I will turn it over to the both of you, and you just send me know, and I will advance the slides.
Meredith Rodriguez: will also click notation that that the subtitles that you are seeing in Spanish, is my screen here computer hasn't gotten crazy, but we have a few a few pre hospital practitioners that are joining us better predominantly Spanish speaking so like to have that up.
Jane Brice: Alright hey my name is Jane bryce I am all the things she said and i'm going to talk about.
Jane Brice: Quality Assurance quality improvement through the peck process more pretty high level and i'm so excited that Robbie is with us today, so that he can talk about boots on the ground and how this really works, where the rubber meets the road, so we can come at it from two different angles.
Jane Brice: I was a paramedic for 16 years before I went back to Medical School, and so I have, I think a really good understanding of what it's like to be in the field, taking care of really sick kids and, like many of you and many of your providers it scared the crap out of me.
Jane Brice: And this process that we have initiated with the generous support of the msc folks through this grant.
Jane Brice: is designed to make it less scary and to provide better care for our pediatric patients, so if you'd advance the next slide i'll get started talking about this sort of high level thing and then turn it over to Robbie so the whole purpose of the pack.
Jane Brice: project is to increase the use of performance measures which are important in the care of children in the pre hospital environment excellent.
Jane Brice: yeah so we went at this in with two different.
Jane Brice: audiences in mind.
Jane Brice: The first thing we did was to provide information for individual providers, we worked with the North Carolina office of the Ms and the msc Advisory Board in North Carolina to identify performance measures.
Jane Brice: For the disease entities that you see listed on the right, and you can see that there are let's see I can see 19 of them.
Jane Brice: I think we actually have 20 courses, and so we worked really hard to identify what are the critical things that Ms providers do in the field that really make a difference in care of really sick kids.
Jane Brice: Once we had identified those performance measures we then develop online education centered around each one of those disease entities and these online education.
Jane Brice: Like you know I took online I took online education, when I was a paramedic and It made me crazy to do a whole hour.
Jane Brice: of education, just to get a few kernels of information and so these courses are really streamlined there no more than eight to 10 slides and they really hone in hard on performance measures for kids.
Jane Brice: One of the things that we discovered and thought was probably true was that email providers don't really know what a performance measure is they're like what the heck is that thing.
Jane Brice: Like Why do I care about that and, and how does that work and my care of the kid like I show up I take care of kids.
Jane Brice: And I go back and clean up my truck that's it so that's not really it, though, is the thing we want to be sure that we're hitting the really.
Jane Brice: standard of care for these kids and giving them their best chance when they're critically ill, and so we developed for courses to talk about.
Jane Brice: What is a performance measure, why is it important to me how do I use this information to be a better paramedic because I have not met a paramedic yet who didn't want to get better and better and better and take excellent care of their patients, and this is a way to do that.
Jane Brice: The other thing we did for the individual cms provider was we developed what we call pars performance adherence reports.
Jane Brice: The these are individualized reports on the care that the paramedic or the emt delivered in the field so for every patient they see their.
Jane Brice: patient care report is scanned electronically and using it software that if you asked me to explain I couldn't possibly do it's.
Jane Brice: All background sophisticated stuff that I don't understand, but it scans it and it helps us to see whether or not you hit those performance measures.
Jane Brice: And then, it gives each individual paramedic or emt information about the care they delivered in the field, so that they can see how well they perform.
Jane Brice: And so that they can take personal ownership over getting better and better and better and delivering excellent care in the field, so those were the things that we targeted for individual Ms providers can you advance the next one.
Jane Brice: The next thing we did was tried to help the helpers so the training officers, the.
Jane Brice: shift commanders the Ms directors, the Ms medical directors, we tried to provide them with information so that they could better health care providers underneath them.
Jane Brice: And so we identified packs in 10 rural counties and to suburban agencies and we provided them with education and ongoing training.
Jane Brice: so that they could then help the providers to get better, we held a peck summit in July of 2021, which was a really our introductory sort of.
Jane Brice: meeting with all the pecs who had stepped forward to participate in this project, and we talked about what are your responsibilities, how do you do Community building, how do you deliver education is using a par.
Jane Brice: And then we launched resources and check in so we check in monthly with all the packs and we're continually released new courses and new information we're continuing to develop and.
Jane Brice: turn out pars and work on an alert system so that packs will get an email when a pediatric patient is encountered in the field so as soon as that.
Jane Brice: patient care report is filed, then an alert will be sent to the Pack that says hey.
Jane Brice: You guys took care of a pediatric patient and here's how you did so that we can give real time or near real time feedback and patient people can get better when while they're still remembering the call next line.
Jane Brice: So.
Jane Brice: what's worked well, so so far we have released a tremendous amount of educational content, the pecs are so engaged and so excited about this and we just love their energy and enthusiasm and working with them they're fantastic folks who are really invested in improving the care of kids.
Jane Brice: we've talked about feedback and it is our intention to change, Ms care over time, by helping providers understand how their performance.
Jane Brice: was delivered and how they can be better that we have developed intro organizational communication system so that they have team meetings.
Jane Brice: And then enter organizational meetings with websites social media newsletters check in via zoom or phone, so that the pecs feel supported and can talk to their peers about how things are going and what's working well next one.
Jane Brice: Thanks.
Jane Brice: who helped.
Jane Brice: So the north Carolina office via mls, in our opinion is like.
Jane Brice: enormously wonderful folks to work with they're so invested in quality improvement they're so invested in performance and they gave us tremendous help and support and getting this off the ground.
Jane Brice: Equally.
Jane Brice: invested were the most agencies we put out our.
Jane Brice: application process and we're inundated with Ms agencies who wanted to deliver better pediatric care.
Jane Brice: And we chose those cms agencies who were best situated to really deliver the content and to make it happen.
Jane Brice: so that they could develop best practices and then we could expand it to other Ms agencies and grow this program in the state of North Carolina but we wanted to start with the best of the best.
Jane Brice: And we used Interagency champions, so people who were really invested in pediatric care, those were the go to people.
Jane Brice: I can go to the Ms director all day until i'm blue in the face, but the number of competing distractions that an Ms Director has budget working with the Community working with the county Commissioners.
Jane Brice: pediatrics here just doesn't rise to the level of keeping the organization going and the lights on, so we had to find champions inside the Agency.
Jane Brice: Who could lead this work and we were so successful on that people really care about pediatrics people really care about delivering good care for children, and we would be dead in the water, without these folks.
Jane Brice: And we then give back to the champions by praising them in our newsletters talking directly to their leadership about how successful they have been.
Jane Brice: And then amount of work they have done, and this is an example on the right here of the ways in which we have done that.
Jane Brice: I think the next slide talks about barriers my right yep So what are the barriers, the barriers were that.
Jane Brice: People don't know what performance measures are like it's a it's like Russian.
Jane Brice: People don't know what that those words are and what they mean and how to use them, and people are so used to being punished or penalized for not delivering.
Jane Brice: The state of the art care that they're really shy about stepping forward and looking at their performance measures because they feel like that they failed in some way.
Jane Brice: And that's not our approach at all performance measures are all about opportunities to get better and to improve the care being delivered in the field.
Jane Brice: But you have to look at the data in order to know where you are.
Jane Brice: In order to know how to get better and getting this message across, has been really difficult because the culture and the Ms for a long time.
Jane Brice: has been punitive and we're trying to turn that on its head and make it be about opportunities for excellence and the more outside organizations you involved in a project, the more people, you have to talk to and get buy in from and sometimes that can slow deliverables.
Jane Brice: We work with a wonderful folks at ESO about our IT infrastructure Those are our wizards.
Jane Brice: That do all the software work and we learned really fast that tiny little tweaks we asked them to make to the software.
Jane Brice: can have massively important unintended consequences so it's important to test your products frequently and particularly to protest them after every update.
Jane Brice: And then yeah most folks are in and out of em is quite a bit moving agencies are moving professions and so you have to appreciate and be prepared for turnover and have.
Jane Brice: duplicity multiple people in the organization, who are champions, who are ready to step forward to step into positions when necessary excellent, I think, is my last yeah sustainability.
Jane Brice: So we don't want this to die when this project is over this is incredibly important, and we have so many people invested.
Jane Brice: The North county office of dms, as we have said, have been so great about working with us, and it is their intention.
Jane Brice: to deploy this across the state of North Carolina not only that, but he also was really excited about the stuff we are doing.
Jane Brice: And they are a national company and have hundreds of EMF agencies working for them and are eager to see how they can deliver this across the country through their infrastructure.
Jane Brice: Within Ms agencies, we intend to increase capacity but also capability to increase peck and clinician knowledge and skills.
Jane Brice: were planning another summit we're thinking about new ways to engage providers and then we're connecting and cross promoting.
Jane Brice: Using some mannequins through the north Carolina msc office, and they have been lovely to work with, and we are so delighted to have them as partners as well, I think that's my last slide in my right, yes, so Robbie What about boots on the ground.
Robby Milton: I am here can you hear me.
Robby Milton: Alright cool so my name is Robbie like she said, thank you guys, for having me on and i'll talk a little bit about what we've done here at our county since joining the.
Robby Milton: PCC program in North Carolina and Dr bryce and everybody at unc so far have been amazing to work with, and we appreciate you guys.
Robby Milton: can go on to the next slide there.
Robby Milton: Alright, so first i'm just going to give you guys a little bit of background about our agency in kind of the population that we serve that way it'll make a little more sense.
Robby Milton: We are located in the foothills North Carolina we have a population of about.
Robby Milton: 91,000 people and that spread out over 515 square miles, so we do have a very, very large county.
Robby Milton: About 18.4% of our population are 18 year or less than 18 years old, so we do have a pretty good pediatric population and our county.
Robby Milton: is home to multiple state owned and privately owned live in facilities for pediatric patients are living institutions so.
Robby Milton: We have state.
Robby Milton: owned a disability centers, such as the average middle Center and brought in hospital, we also house the north Carolina school for the deaf, which is, I live in.
Robby Milton: School for the Deaf and hard of hearing a lot of pediatrics there and then some other privately owned children's institutes, so the reason we decided to really try to go after the PCC program is because our practitioners here working Ms really, really run a high.
Robby Milton: risk of running a pediatric patient, we have a lot in the county and we want our pediatric care to be the best it can be for those who live here so.
Robby Milton: The other thing is that our local hospitals have know in in paid Inpatient pediatric services, so any pediatric that scene in the er.
Robby Milton: And then subsequently needs to be admitted has to be put back in an ambulance and taken out of town to another hospital service that will admit them so.
Robby Milton: Some of these kids are very, very sick when they're transferred so not only do we have a high incidence of seeing these.
Robby Milton: pediatric patients, but a lot of the pediatric patients that we see are very sick and we can be in the truck with them for up to an hour hour and a half, two hours, while we're transferring them out of town.
Robby Milton: or English go ahead, the next slide.
Robby Milton: So Burkina mass is the primary and only ALS pre hospital provider for our county we deploy about eight ALS units and one supervisor 24 seven.
Robby Milton: Monday through Friday during the day, we do have additional two additional units own to help support the call volume.
Robby Milton: And then we run to administrators that administrate for about 110 employees, which is what our service is and that's made up of a mix of empties emt paramedics and a couple of critical care paramedics.
Robby Milton: Next slide please.
Robby Milton: Okay, and this is how our structure for our services broke down.
Robby Milton: We have a director and a major.
Robby Milton: Who are the two administrators and that major serves both as the agency's training and quality management officer, but also as.
Robby Milton: The operations commander, we have four chefs and each one of those shifts has a captain lieutenant and a sergeant each you have a specific job or role within that shift the captains, of course, are the shift commanders.
Robby Milton: The sergeant's on each shift, however, are responsible for.
Robby Milton: Training and any qm or Q out of that goes on on the shift so those sergeants are responsible for.
Robby Milton: reviewing these submitted.
Robby Milton: electronic health records from all of our.
Robby Milton: clinicians to verify protocol compliance and that kind of thing.
Robby Milton: You go ahead to the next slide there.
Robby Milton: Alright, this is just again some call statistics for our service.
Robby Milton: We ran about just chop 16,000 in 2020.
Robby Milton: Out of that 603 of them were 16 year olds years older less.
Robby Milton: About 8% or 17 out of that 630 were transported lights and sirens or considered critical.
Robby Milton: And then, out of that 603 pediatric calls in 20 we had for pediatric cardiac arrests and one of those calls that none of us like grown, but unfortunately come.
Robby Milton: With what we do.
Robby Milton: The great thing is that, out of all four of those we have 100% Ross great one of those risks was obtained by our first responders before Ms arrival.
Robby Milton: And then, out of those four pediatric arrests, one of them had an advanced airway placed, which was a 100% success.
Robby Milton: Next slide please.
Robby Milton: Okay, so this is kind of how our QA process went here before we got involved in the PCC Program.
Robby Milton: When we ran a pediatric call, we would provide quality briefings if needed if it was a critical call, and that would be for everybody involved.
Robby Milton: From the practitioners, all the way down to the dispatchers who dispatch the call any first responders law enforcement everybody who was involved.
Robby Milton: And then we would try our best to follow up with additional debriefings if possible.
Robby Milton: Or if needed.
Robby Milton: Hours shift starts at sonic shift will review those electronic health records.
Robby Milton: To check for protocol compliance and make sure that kind of best practice was followed if during that review.
Robby Milton: It was revealed that there was either poor quality care for that patient or there was any significant protocol deviation.
Robby Milton: Then that review would be forwarded from our sergeant to our major and medical director for further review once our major and our medical director.
Robby Milton: reviewed the call reviewed the chart and gathered any information that they needed, they would then direct an action plan, whether that be remedial training.
Robby Milton: Whatever else needs to happen.
Robby Milton: Alright, so what worked well and what didn't.
Robby Milton: What did work well, is that it gave us a very thorough review of any selected ehr.
Robby Milton: or electronic health record of a pediatric patient.
Robby Milton: Our sergeants are very diligent and very.
Robby Milton: well versed in in policy and protocol so in reviewing those charts they were.
Robby Milton: Very well suited to make sure that there was no significant deviation or poor quality of care.
Robby Milton: And then, of course, that verified protocol compliance, what did not work with that setup was that there was no way for us to catch every pediatric chart that was submitted.
Robby Milton: which I think is a problem for a lot of agencies.
Robby Milton: Especially agencies who run a significant amount of calls.
Robby Milton: You have to work very, very hard to make sure that you try to catch every pediatric turn this video and sometimes that just doesn't happen.
Robby Milton: The other thing is that there were no specific benchmarks or points of care that we checked for other than to make sure that.
Robby Milton: The North Carolina state office of Ms protocols were followed.
Robby Milton: So things like.
Robby Milton: medication dosages and that kind of thing we would verify that they were correct, but other than that there were no specific.
Robby Milton: benchmarks that every call was was ran against.
Robby Milton: Another thing that didn't work about that Kim process was there was very, very little follow up.
Robby Milton: And no direct platform or modality, for us to.
Robby Milton: receive any feedback, especially on the outcomes of our patients.
Robby Milton: Which.
Robby Milton: feedback and outcomes play a huge role in directing your quality management process so it's one of the things we really wanted to fix next slide please.
Robby Milton: Alright, so implementation once we were selected for the PCC program we were very excited.
Robby Milton: and the first thing we did after receiving all of our information and going to the PCC Summit was to.
Robby Milton: introduce our entire service to the PCC program and what it does.
Robby Milton: Specifically, we wanted to provide an introduction.
Robby Milton: On an education on what benchmarking is and what performance adherence reports are to our clinicians we thought it very important to make sure that.
Robby Milton: All of our staff our clinicians knew more than just hey we're going to implement this new Program.
Robby Milton: We wanted to make sure that they knew what the program was in while we were doing it, which that means making sure that all of our clinicians understood that.
Robby Milton: Ms in the last several years has changed a lot, and will continue to change a lot and quality improvement in quality assurance are what is going to drive.
Robby Milton: The Ms agencies and healthcare forward so we wanted to try to make sure that our clinicians understood that process and really knew.
Robby Milton: What the PCC program go was.
Robby Milton: In doing that, we reviewed the parse or the performance adherence reports with our staff.
Robby Milton: showed them how they work, how they're going to be reviewed, what the different benchmarks are four different call types.
Robby Milton: And then.
Robby Milton: kind of devised a way to give them some feedback on the pediatric calls that they run.
Robby Milton: Next slide please.
Robby Milton: So into the future, looking forward now from from now for the PCC program for Burke.
Robby Milton: we're looking forward to the implementation of the so alerting system that Dr bryce talked about.
Robby Milton: That will ensure that our.
Robby Milton: Services not missing the review, you have any of our pediatric calls.
Robby Milton: Having the system alert me that pediatric call has been put in will make sure that nobody misses any.
Robby Milton: And then those of course will be around against those performance adherence reports and ensure that all the benchmarks are met.
Robby Milton: we've also added the addition or in the process of adding.
Robby Milton: Random weekly reviews of pediatric calls, whether they had anything wrong with them or not, even if it was a call that everything was met perfectly the cars.
Robby Milton: had all the correct benchmarks met we're still going to review those.
Robby Milton: Above and beyond just the normal review that the sergeant on each shift does and that's just so that our major and medical director.
Robby Milton: lay an extra set of eyes on a lot of these calls.
Robby Milton: The other thing we're hoping to do soon is to add a.
Robby Milton: Third administrator for our service.
Robby Milton: Possibly a second majors position, which would.
Robby Milton: Give us the ability to.
Robby Milton: Make sure that there's one person overseeing a lot of this quality management efforts and can work very closely with the PCC which would be me to make sure that.
Robby Milton: Our processes are being followed.
Robby Milton: And then, a couple other things that we've done.
Robby Milton: we've recently.
Robby Milton: researched and started to purchase some new pediatric equipment for our service things like the sort of dose.
Robby Milton: syringe dosing kits that helped our clinicians ensure that they're giving the correct gnosis of medication.
Robby Milton: Replacing our pediatric color coded bags updating browser systems that kind of thing and then another thing we're looking into is the addition of the hospital data exchange system through so.
Robby Milton: it's something our systems not had before, something we would be very excited about getting because it would give us a direct modality, to obtain.
Robby Milton: feedback and outcomes on the pediatric patients that we deliver to the emergency department.
Robby Milton: One of our biggest complaints now is that we drop off these kids at the end, but never get any feedback or follow up on how the kids did after we dropped them off so.
Robby Milton: Having the health data exchange, or the hospital data exchange through ESO would give us that ability and then would give us the further ability to.
Robby Milton: improve our quality management process for our for our kids an excellent.
Robby Milton: And that's it for me.
Meredith Rodriguez: Thank you, both.
Meredith Rodriguez: presentations it's a great program it's it's awesome to see how it's being implemented any questions for Dr bryce it for Robbie.
Meredith Rodriguez: you're welcome in this breakout you can come off mute you can turn on your cameras and ask if you'd like or you can use the chat box.
Louis Gonzales: Okay, so i'll kick things off.
Louis Gonzales: Very good presentation both Dr brace and Robbie.
Louis Gonzales: Have a question I.
Louis Gonzales: noticed, you know really good programming looking at provider individual publisher performance and i'm curious about whether you also have any system level measures.
Louis Gonzales: And if so, where are you how are you how are you tracking those for question number one, and the second thing is, is how are you using them to then foster quality improvement.
Jane Brice: yeah so the entire purpose of this project was focused on improving individual performance, so we do not have system level measures.
Jane Brice: As as you likely know, as I talked about initially we're targeting rural systems and, as you likely know in a rural system.
Jane Brice: they're going to be lucky if they have to pediatric calls a month, so developing system measures is really hard because of the low numbers.
Jane Brice: The low numbers is actually what makes it so important to give individual provider feedback, because you so infrequently see really sick kids.
Jane Brice: and being able to give really good individualized feedback on performance measures in real or near real time for those cases, we found to be very compelling.
Louis Gonzales: Great Thank you very much.
Meredith Rodriguez: Maybe a follow up question as for today's focus has been around policies and procedures and curious either you Dr bryce or IBM.
Meredith Rodriguez: If you know of any sort of policies or procedures that have been established or put in place at any of these agencies to really reinforce some of these performance adherence measures.
Jane Brice: So i'm going to start but i'm definitely going to turn this immediately over to Robbie and what I want to say is that we wanted to empower agencies to do what works for them.
Jane Brice: I mean there's this old adage right if you've seen one emr system you've seen one emr system because they each function, they have their own culture and function distinctly differently, one from another.
Jane Brice: And so we wanted to empower and honor the culture of each individual agency and allow them to create what works for them in terms of policies and so Robbie i'll let turn it over to you soon talk about what you guys didn't work counting.
Robby Milton: So.
Robby Milton: We had.
Robby Milton: Before the PCC program a good bit of specific policies towards our our pediatric care.
Robby Milton: That were kept you know, mostly up to date and we're good policies that everybody followed and what we found through the introduction of these performance adherence reports are that, even though some of the reports would say that.
Robby Milton: Either way, weren't meeting specific benchmarks or standards.
Robby Milton: When we actually reviewed the calls, we were meeting those so we understood very quickly that one of the.
Robby Milton: Areas of needed improvement with our service was our documentation and charting of pediatric patients.
Robby Milton: So.
Robby Milton: That was the first big hurdle that we tackled was reviewing all of our current.
Robby Milton: Directives, as far as documentation of pediatric patients and realized very quickly that we needed to number one revisit that number to hold some training with our staff members to.
Robby Milton: update them on exactly how to provide.
Robby Milton: Good documentation for a pediatric patient.
Robby Milton: Things like making sure that there was a a white listed in every chart for pediatric patient or.
Robby Milton: making sure that we listed what color they measured on the links by state or.
Robby Milton: Obtaining a pain level for a pediatric patient things that that our clinicians we're doing just weren't making it into the documentation so.
Robby Milton: changing some of our documentation policies was our initial focus and we've kind of gotten through that now, and the partners have improved our compliance has improved.
Robby Milton: And our overall documentation, as far as pediatric patients has improved 100% and our clinicians seems to seem to be a lot happier with it.
Meredith Rodriguez: To kind of a follow up on that I know this touched on this really quickly at the end and sort of measuring that are gauging that so when you looked at sort of the documentation practices and how.
Meredith Rodriguez: How that was being improved did you maybe look at specific measures around that or how did you really gave in one area.
Robby Milton: So we actually used the pars themselves to kind of direct that so and there are other reports within so that you can generate that will show you.
Robby Milton: Compliance for making sure that.
Robby Milton: pain scores or weights or things like that were documented in the charts.
Robby Milton: So one of the things we did was to compare before we revisited those policies and did the training to after and you can see a significant increase.
Robby Milton: In the.
Robby Milton: Adherence to those specific benchmarks for the the charts.
Robby Milton: Also, just by speaking with our clinicians through our training and afterwards.
Robby Milton: they've all kind of expressed that they're.
Robby Milton: much happier with their own documentation and pediatric patients and that.
Robby Milton: They understood afterwards, looking at it that they really needed that extra training and we really needed to fix the way we were document in our pediatric patients.
Meredith Rodriguez: i'm so glad you said that because you know I think when we think about measurement sometimes we get a little stuck on having having to be used quantitative measure.
Meredith Rodriguez: And I think really there's a lot to put in place a lot of start to put in place and just talking to your staff and really understanding how their opinions i'm i'm really how's it going Is this something to not be sort of underrated.
Robby Milton: Right.
Meredith Rodriguez: Other questions.
Meredith Rodriguez: I know this, I.
Meredith Rodriguez: want to give everyone an opportunity to chime in here and learn about the program or learn about.
Jane Brice: So there's a question in the chat i'm about verbiage or communication tools to help rural agencies hospitals develop pediatric specific.
Jane Brice: policies and procedures and.
Jane Brice: Probably what made this really important for you.
Robby Milton: So one of the things that made it the most important for us is.
Robby Milton: The amount of.
Robby Milton: Special Needs pediatric.
Robby Milton: Patients we have in our jurisdiction, so, as I said during my presentation we have.
Robby Milton: A really high number of.
Robby Milton: living in institutions for those with disabilities.
Robby Milton: Specifically, those with pediatric disabilities.
Robby Milton: So the incidents or the occurrence of our clinicians running really sick.
Robby Milton: Special Needs children is high, because of that, and you take into account like we said earlier that.
Robby Milton: All Ms conditions, mostly are scared of pediatric calls because it's just something we don't do a whole lot so you add that, to the fact that we have a really high number of very sick.
Robby Milton: disabled children in our jurisdiction, it was very important to us to do something to make sure that our clinicians were both prepared and confident enough in their self to be able to handle those situations.
Jane Brice: As an Ms medical director, from my perspective when i'm thinking about where I want to focus and put a lot of attention in terms of education or policies or procedures or QA I really think about what are the high risk.
Jane Brice: calls that we respond to and yes cardiac arrest is a high risk call we respond to, but we see a fair number of those and so yeah most providers get pretty good experience on an annual basis and seeing.
Jane Brice: cardiac arrest and managing those we see a fair number of strokes and sepsis and.
Jane Brice: amies so it's really it's not easy but it's much easier to change care in those patients because there's lots of opportunity to practice.
Jane Brice: The calls that is a medical director scare me to death or those high risk but low volume calls where there's not an opportunity to change culture or to change practice because you see, so you have those patients.
Jane Brice: And so, providing lots of opportunities in lots of different ways simulation online education.
Jane Brice: Focus groups talking about the care provided and giving best practices from one provider to another.
Jane Brice: support groups other kinds of ways to penetrate and change culture and care for the high risk but low volume calls that's where I want to put a lot of time and attention that's where the biggest bang for the buck is for me.
Louis Gonzales: um if I could add to what Dr bryce just just mentioned me putting my other hat on my.
Louis Gonzales: Previous Ms role hat that's not really the one I were much anymore, these days, but in my previous role we actually did something like that and we defined actually by a specific policy of.
Louis Gonzales: What type of races described as high risk, low frequency events different both adult and pediatric patients but it's a it's a great way to kind of codify it put it into policy, this is what we do in our organization works great when you have your medical directors backing.
Louis Gonzales: And, even in the city of Austin.
Louis Gonzales: With a very, very forward thinking.
Louis Gonzales: city government there was opposition to or questions I should say about why would you look at those Why would you look at the things that don't happen very often.
Louis Gonzales: And it took some.
Louis Gonzales: Really face to face.
Louis Gonzales: In a kind of discussions with our.
Louis Gonzales: Government leaders who were involved with performance measures.
Louis Gonzales: To get them the value of doing that so sometimes it's it's going to take as as Catherine, as you, as you mentioned, there, it does take some conversations about why that's important because it's very hard to see why how how low frequency events, I really important to measure.
Louis Gonzales: And and it's really the reason why we we focus a lot on pediatrics and especially in the Ms world is because it's low frequency, it makes it more important, just because it isn't the kind of the thing that we do every single day, every hour it's a treatment, so a very good question.
Louis Gonzales: and
Louis Gonzales: Again, I would suggest you know, identifying where those those specific categories of patients.
Louis Gonzales: Including pediatrics.
Louis Gonzales: And then, focusing on those and measures so that it's not just the beads it's also all the other high risk, low frequency kinds of patient populations.
Meredith Rodriguez: Catherine had a follow up question test and would that be a good use of stadium sm sister trauma data to help determine those high risk, low frequency categories.
Jane Brice: I think state trauma data can definitely give you low frequency I don't think it's going to give you high risk because that's really sort of a medical opinion about.
Jane Brice: What are the highest risk kinds of cases that Ms provider see in the field, so it can give you one half of that equation, but I don't think I gave you both and i'm not sure trauma data is the best use, but I do agree state nemesis data would be very helpful for understanding call volumes.
Meredith Rodriguez: So i'm curious if anyone else on the call is really done something similar and their spirits work through sort of this performance measures, looking at adherence looking at improvement and really implementing.
Meredith Rodriguez: A process or policies or procedures to help support that they'd like to share.
Meredith Rodriguez: quite good today, I think this this topic is a little bit harder than less than a committed supplies medications that we touched on last month, so.
Louis Gonzales: i'm married, I have a question for Robbie.
Louis Gonzales: In your organization branded as you because I believe you you're the identified pack So is there is there something in your organization that.
Louis Gonzales: creates that role, like is there a policy that says, we will have a pack of these are the kind of the responsibilities of that person because it's great that you're identified as that person, so does your organization support that through some policy or something like that.
Robby Milton: We initially didn't have a policy for that now.
Robby Milton: And really had never thought about assigning just one specific person like I said before, the quality management quality assurance of.
Robby Milton: Any call especially pediatrics was just left up to each sergeant elite shift.
Robby Milton: Through.
Robby Milton: applying for and then being accepted into the program for North Carolina.
Robby Milton: We have since created that and now have the specific position for it.
Robby Milton: I think that, like I said each agency having that one person works much, much better it did for us because it ensures that the program continues to move forward, it ensures that you have one central point of contact for this population.
Robby Milton: and
Robby Milton: It ensures that.
Robby Milton: All of your pediatric calls are being reviewed and held against the same standard by one person, instead of multiple multiple different people.
I think that's crucial in that's a good point.
Meredith Rodriguez: And maybe in the last few minutes that we have here kind of do a little crosswalk between the key drivers that we sort of talked about in the main session today in sort of.
Meredith Rodriguez: How you all have developed and implemented this program and so.
Meredith Rodriguez: They think you know, one of the key things, one of the key drivers that we talked about is communication and really obtaining both staff buy in and leadership buy in, and I know that Dr bryce and Robbie both talked about.
Meredith Rodriguez: Getting a leadership on board and really how to sell that and so that's definitely one area to approach this with.
Meredith Rodriguez: And then we have education as another one of our key drivers and we've touched on that as well as you know, Robbie talks about re educating the staff on good documentation practices and really analyzing that.
Meredith Rodriguez: So, really, you know, focusing on a specific area where you can start to improve based on some of these drivers another driver that we talked about in the main session was tools and resources and we talked about with the performance adherence reports there's checklists and there's.
Meredith Rodriguez: The alert system there's even there's newsletters and check into the individuals and so all these sort of tools and resources.
Meredith Rodriguez: That they put in place to really ensure that this program is successful and they talked about really kind of building a team identifying the pecs in each agency and really connecting them and really establishing a Community.
Meredith Rodriguez: In hosting these different these intro and Interagency really connections, I think it's extremely important to driving improvement and.
Meredith Rodriguez: Some of the other ones we talked about was really establishing the Culture around this and really how you kind of build a culture on improvement and Dr bryce touched on how we.
Meredith Rodriguez: You know we're really focusing on the shift from this more punitive nature around improvement in quality insurance to really took quality improvement and how we can really.
Meredith Rodriguez: Look at performance adherence and and look at these measures as a tool for improvement and not really to place blame or to really establish any sort of punitive culture that's a huge cultural shift in a lot of our agencies that we see.
Meredith Rodriguez: And I know lose if you can think of any others and kind of talk through this to tell what you decide to to.
Louis Gonzales: Well, I am always curious whenever the topic of culture and quality or discuss it always raises questions in my head, but I do have one for.
Louis Gonzales: Robbie in terms of what the work that that your group is doing in terms of these pars.
Louis Gonzales: How how's your did you have to make some changes in your culture or was your was your culture already there in terms of making it non period, especially when discussion of things like.
Louis Gonzales: Oh, you didn't meet the measure you know, meaning you, like me, specifically Lewis you didn't meet the measure.
Louis Gonzales: Some managers think that is a little risky because you're talking about we didn't do as good a job, as we should have so how did you deal with that.
Robby Milton: that's a great question, it was.
Robby Milton: Initially, somewhat difficult because.
Robby Milton: I think the there is a stigma in the Ms that anybody who looks over your charts is just trying to get you in trouble for something or get you in trouble for missing something.
Robby Milton: So it was very important, when our management team set down to discuss this implementation that we talk significantly about.
Robby Milton: Making sure that our clinicians understood that this was not a punitive thing and part of that was to really provide education on.
Robby Milton: The.
Robby Milton: fact that cms has made leaps and bounds, in the last several years and will continue to do so, and part of that was the emr systems are now more than ever considered a part of the healthcare system in general.
Robby Milton: And those of you who work in other parts of healthcare i'm sure I understand that.
Robby Milton: Quality Assurance quality compliance patient satisfaction things like that are.
Robby Milton: really being considered, especially when it comes to the quality of care.
Robby Milton: And things that relate to whether players will eventually pay for these these trips or not, so we tried to make sure that our in our clinicians understood that.
Robby Milton: reviewing these bars and reviewing these benchmarks are in no way.
Robby Milton: In an attempt to.
Robby Milton: penalize them for missing, something it is strictly to make sure that we are meeting the best quality standards of care.
Robby Milton: For our pediatric population.
Robby Milton: And as we move forward as a productive.
Robby Milton: group within the healthcare system these benchmarks and this quality improvement process is going to be extremely important, so we tried to come at it from that angle, instead of.
Robby Milton: You know this is just something to make sure that.
Robby Milton: you're not missing anything.
Louis Gonzales: Thank you Robbie maybe additional questions anyone has.
Stephanie Ashford: Robbie do you guys use just culture and your disciplinary procedures.
Robby Milton: No, we don't.
Stephanie Ashford: That was a big help for our department, when we were implementing this type of a quality, performance review was to incorporate just culture into our actual.
Stephanie Ashford: Performance improvement and disciplinary procedures so that there was a very clear and concise path that helped our crews understand the non punitive nature of error reporting.
Robby Milton: Okay.
Louis Gonzales: that's a really good point stephanie and glad you brought that up that's a topic couple of will be discussing in our learning session in March on on quality improvement but definitely important stephanie i'm wondering, did you did your group.
Louis Gonzales: Provide actual people some external just cultural training for your management and you started that.
Stephanie Ashford: We did we had to upper management go through like a week long course and then all up the middle layers of our leadership have got at least an eight hour course and some of them got sort of an extended version.
Louis Gonzales: that's great.
Louis Gonzales: Anything else.
Meredith Rodriguez: hi good, I want to thank Dr bryce and Robbie for your time today and.
Meredith Rodriguez: Sharing your wonderful work with us, I think Kathleen has a question.
Meredith Rodriguez: asked what courses you provided.
Jane Brice: yeah actually you're on the right slide so we've provided courses on all the things on the right hand side of that slide plus four courses about performance measures and how to use them.
Jane Brice: Oh sorry culture coaches.
Okay.
Meredith Rodriguez: Okay well quick reminders of what's coming down the Pike will have the open office hours here in December 16 it's an hour just open come with the questions comments concerns and try to get them answered.
Meredith Rodriguez: And then we'll January six right after the holidays we'll jump into care team competencies and really look at how you can evaluate and implement pediatric competencies.
Meredith Rodriguez: And with that I just want to thank you all for your time Thank you again, Dr bryce and Robin for your time and sharing your wonderful expertise and we will see y'all a little bit later this will be recorded and i'll send an email wants to post it.
Meredith Rodriguez: Thank you guys.
Louis Gonzales: Thank you.