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Mayor, Hospitals Announce New Initiatives for Systemic EMS Reform


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Mayor Adrian M. Fenty, Councilmember-At-Large David Catania, Fire and Emergency Medical Services Department Chief Dennis Rubin, Director of the Department of Health, Dr. Pierre Vigilance and the chief executive officers of the District’s busiest hospitals announced two initiatives that will continue the Administration’s reforms of EMS and access to health care in the District. Both initiatives announced today respond directly to Recommendation 5 of the EMS Task Force to reduce misuse of EMS and delays in patient transfers.


“To make the District’s EMS the best in the nation, we need to reform the entire system,” said Fenty. “I am pleased that our partners in the hospital community are working with us to meet that challenge.”


New Fire EMS Closure and Diversion Policy

As part of the Hospital CEO Working Group recommended by the Task Force and established by the city administrator in November, District hospitals with the city’s Fire & EMS and Health departments have agreed on a new policy that will govern temporary closure and diversion of hospital emergency departments (ED), as well as the delivery of patients to hospitals by EMS transport units. The new policy seeks to ensure that no single aspect of the District’s emergency medical care system is unduly burdened by the high demand for ambulance services, while also striving to achieve the highest possible quality of patient care.


Research by the task force found that the District has some of the highest closure and diversion rates, and among the longest “patient drop times,” in the country. Currently, Fire & EMS has an average patient drop time of 40 minutes, which impacts the ability of District ambulances to get back on the streets and respond quickly to emergencies. The new policy includes a goal of dropping off patients within 25 minutes, a change that, if realized on a regular basis, will have the effect of adding five additional ambulances to District streets. The policy also facilitates improved District management of transport unit flow to hospitals, as well as more seamless information sharing between hospitals and the Fire & EMS Department.



“We appreciate the efforts by the Mayor's team to improve the EMS by enhancing coordination with the city's hospital emergency departments and strengthening the response to patient needs,” said James F. Caldas, president of Washington Hospital Center.


Emergency Care Reform Initiative

High rates of closure and diversion and long patient drop off times are symptoms of unnecessary stress on EMS due, in part, to overuse of hospital Emergency Departments. The Emergency Care Reform Initiative (ECRI) will address this challenge through a collaboration of city agencies, health care providers, and community partners that serve residents at risk for seeking emergency care services. Mayor Fenty’s FY 2009 budget dedicates $1 million to support the initiative, the goals of which are to develop high-impact strategies that reduce avoidable hospitalizations, preventable ED visits, and non-emergent EMS transports.


“Turning to EDs for everyday health care use is a national phenomenon,” said Mayor Fenty. “But here in the District, we are committed to reversing this trend and making sure that every resident is linked to an accessible medical home in their community.”


The Emergency Care Reform Initiative will include a series of projects ranging from a $10 million chronic disease management and prevention grant program, to the development of a non-emergent transport system to serve as an alternative to EMS transport for residents in urgent but not life-threatening conditions, to street outreach connecting high risk homeless residents to preventive care and a medical home.

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