Inquiry into Public Hospital Performance
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Inquiry into Public Hospital Performance Ambulance Victoria Presentation 2 December 2009. Greg Sassella Chief Executive Officer Tony Walker General Manager Regional Services Mark Rogers General Manager Specialist Services Alex Currell General Manager Strategy & Planning.

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Inquiry into Public Hospital Performance

Ambulance Victoria Presentation

2 December 2009


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Greg Sassella

Chief Executive Officer

Tony Walker

General Manager Regional Services

Mark Rogers

General Manager Specialist Services

Alex Currell

General Manager Strategy & Planning

Ambulance Victoria representatives


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Creation of Ambulance Victoria

  • Government announced the creation of Ambulance Victoria in April 2008

  • Three previous services to merge into one:

    • Alexandra and District Ambulance Service (ADAS)

    • Rural Ambulance Victoria (RAV)

    • Metropolitan Ambulance Service (MAS)

  • Integration activities included:

    • Implementation of $187m new initiatives announced by govt.

    • Negotiate EBA

    • Begin integrating business and finance systems/IT

    • Implement new organisational structure


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Part 4 – Ambulance Services

15. Objectives of ambulance services

The objectives of an ambulance service are –

To respond rapidly to requests for help in a medical emergency;

To provide specialised medical skills to maintain life and to reduce injuries in emergency situations and while moving people requiring those skills;

To provide specialised transport facilities to move people requiring emergency medical treatment;

To provide services for which specialised medical or transport skills are necessary;

To foster public education in first aid

Ambulance Services Act 1986


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Ambulance Victoria is a critical link in Victoria’s health care system and aims to improve the health of the Victorian community by providing high quality pre-hospital care and medical transport

AV provides the following services:

Emergency medical response, pre-hospital care & transport

Non-emergency patient transport

Major incident management & response

Air ambulance

Adult retrieval services

Community education

Ambulance Membership Scheme (insurance)

Ambulance Victoria’s Role


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Career staff (FTE) care system and aims to improve the health of the Victorian community by providing high quality pre-hospital care and medical transport

Over 2,400 operational paramedics

Approx 275 operational managers & support staff

Approx 320 administrative staff

Approximately 1,000 volunteers

Over 550 ambulances & patient transport vehicles

4 fixed wing aircraft & 5 helicopters

224 response locations

$507 total revenue (2008-09)

Operating Revenue; 54% Government, 18% Transport Fees, 17% Memberships, 1% Other

Non Operating Revenue; 8% Capital, Other 2%

Ambulance Victoria’s Resources


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Total of 720,891 incidents requiring dispatch care system and aims to improve the health of the Victorian community by providing high quality pre-hospital care and medical transport

Total of 593,398 patients transported

Road ambulance operations:

433,549 emergency incidents

280,813 non-emergency incidents

587,405 patients transported

Air ambulance operations:

4,606 fixed wing transports

1,387 helicopter transports

Adult Retrieval Victoria (ARV) operations:

1,584 medical retrievals

Ambulance Victoria activity 2008-09


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Ambulance Victoria performance measures care system and aims to improve the health of the Victorian community by providing high quality pre-hospital care and medical transport

  • Response time

    • Measurement includes call answer to arrival at scene

  • Quality of care

    • Audits of paramedic treatment

    • Satisfaction surveys

  • Patient Outcomes

    • Patient medical outcomes

  • Satisfaction

    • Community

    • Health sector

    • Patients


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Ambulance is an integral part of the health system care system and aims to improve the health of the Victorian community by providing high quality pre-hospital care and medical transport

Initial access to care for many emergency patients

Emergency demand

Average 5.5% pa since 2004-05

Ambulance/ED presentations

26% of ED presentations by ambulance (major hospitals)

41% of Triage Category 1 to 3

Ambulance role in demand management

Metropolitan referral service for low priority callers

No emergency ambulance dispatch to 7% of callers

Meet patient needs, reduces ED and ambulance demand

Ambulance & the health system


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Telstra “000” call-taking and ambulance dispatch care system and aims to improve the health of the Victorian community by providing high quality pre-hospital care and medical transport

Emergency Services Telecommunications Authority (ESTA)

Call answer

Prioritise

Dispatch

Response process

Activation (crew alerted and responding)

Reflex (travel to the scene)

At scene (locate, treat, load patient)

Transport (from scene to hospital)

At hospital (triage, patient transfer and cleared time)

Response Time (“Call Answer” to “At Scene”)

Total Case Time (“Dispatch” until “Cleared”)

Ambulance Response Time Components


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Ambulance/ED interface care system and aims to improve the health of the Victorian community by providing high quality pre-hospital care and medical transport

  • Performance at the ambulance/ED interface

    • Direct impact on time for patients to access care

    • Impact on ambulance availability & response time for next emergency

  • Key current processes to manage interface

    • Hospital bypass

    • Hospital Early Warning System (HEWS)

    • Patient transfer escalation process

  • Access & arrivals

    • Pilot system currently under development (Arrivals Board)

    • Real time sharing ambulance arrival & hospital capacity data

    • Early preparation for arrival & early warning of delays


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Patient Transfer Time- Escalation Process care system and aims to improve the health of the Victorian community by providing high quality pre-hospital care and medical transport

  • The time from ambulance arrival at ED to the time patient is transferred from ambulance stretcher to ED bed

    • Delays at this interface affect ambulance availability

  • Escalation of issues is dealt with in real time

    • Ambulance Communications Centre alerted

    • Frontline ambulance managers attend ED’s

  • Patients cared for by paramedics when delays experienced at ED


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Victoria’s trauma system care system and aims to improve the health of the Victorian community by providing high quality pre-hospital care and medical transport

Ambulance triage to Major Trauma Service (MTS) if within 30 minutes

Minimise time to appropriate medical care

Reduction in risk of mortality from major trauma

Over 80% major trauma patients receive definitive care at an MTS

Acute Coronary Syndrome patients

Transmission of 12 lead ECG from scene to hospital

Pilot completed in 2008 & now rolled out to 9 hospitals

Early activation of hospital cardiac team

Ave ‘door to balloon’ time reduced from 106 min to 56 min at 90th percentile (pilot)

Funding received for statewide expansion of model

Stroke patients

Less formal arrangements to transport to specialist stroke units

Improved paramedic identification of stroke

Improving system performance


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