Question

Process Mapping: Hospital Response Chain (A Question for the course of Introduction to Information System)

When someone calls 9‐1‐1, there are a series of actions and responses that get triggered, collectively known as the pre‐hospital response chain. This chain is described below.

The Call for Help

When an individual experiences a medical, they typically call 9‐1‐1 for help. It is important that the patient stays on the phone to provide the necessary information about the emergency situation. The patient relays important information to both 9‐1‐1 and the health communication centre.

9‐1‐1 Emergency Service

The 9‐1‐1 dispatcher's responsibility is to take the 9‐1‐1 call for help and determine if the situation requires police, firefighters or ambulance services. In some emergency situations, more than one service can be dispatched2. The 9‐1‐1 dispatcher also needs to identify the patient’s location so that the appropriate type of ambulance can be dispatched (land, air or water)3. To make these assessments, there are a series of questions that are asked. The patient plays an important role in answering these questions. The 9‐1‐1 dispatcher collects all of the information needed to make these assessments and enters it into the 9‐1‐1 system. Once all the pertinent information has been collected, the information and   call   are   then   immediately   transferred   to   the   health   communication   centre.   Otherwise,   the dispatcher continues to work with the patient on understanding the situation.

Health Communication Centre

The health communication centre’s (HCC) responsibility is to review the information sent by the 9‐1‐1 dispatcher and speak to the patient to assess the nature of the situation and, most importantly, prioritize the response of the ambulance services. Additional information from the patient is typically required to do so. Prioritization is key in situations where there are multiple emergency situations. If the HCC dispatcher determines that the situation is urgent, the medical and emergency information, as captured in the HCC system, is transferred to the ambulance service, and the required number of ambulances dispatched to the scene. In situations that are not considered urgent, alternative methods of transportation are then arranged.

Ambulance Service

An ambulance service has a series of responsibilities when they are dispatched. The ambulance service is alerted to the emergency via their on‐board system.    Using the location information provided, the ambulance service is then responsible for ensuring the appropriate route is taken using the navigational component of their on‐board system. Depending on the weather conditions, location, and time of day, the best route may change. Once the ambulance service arrives at the scene, they are responsible for assessing the situation and determining whether the patient needs to be stabilized at the scene first. Depending on location, assessment, and priority, the ambulance service first determines which hospital is best suited for the patient. If the patient requires stabilization, the ambulance service will work with that hospital to stabilize the patient. Specifically, they speak with the doctors at the hospital using their hands‐free mobile phones to relay the status of the patient and to receive stabilization instructions. The patient is not transported until they are in a stable condition. Once the patient is stabilized, the ambulance service continues to work with the doctors to determine whether the patient’s situation is still critical and requires hospital care. If that is no longer the case, the ambulance service will return to their dispatch station and complete a vehicle and supply report and a scene report.

On route to the hospital, the ambulance service will relay all critical information to the destination hospital using their on‐board system as well as calling them to provide an updated patient status and estimated time of arrival. This enables the hospital to complete all the necessary preparations. When the ambulance service arrives at the hospital with the patient, the patient’s status is verbally transferred to the receiving physician at that hospital. At this point, the physician and team of health professionals assess and care for the patient.

After the patient transfer is complete, there are a series of reports that need to be written and submitted by the ambulance services: 1, Patient Care and Transfer Report; 2, Scene Report (if needed) 3, Patient Invoice 4, Vehicle and Supply Report

The patient care and transfer report is used by the hospital to fill in the patient chart and can be used to determine on‐going treatment. The ambulance service completes this report before leaving the hospital using their on‐board system and electronically submits it to the hospital. When this report is created, a scene report is not needed. A scene report is only created when the patient is not transferred to a local hospital, but assessment and care are provided at the scene. The scene report is for internal tracking purposes.

A patient invoice will be sent to the patient through the mail by the ambulance service: the typical cost for an ambulance service is $45 but if the receiving physician deemed the trip to be unnecessary, the bill will increase to $240. This information is provided by the physician in his verbal report to the ambulance service before they leave the hospital.

Finally, a vehicle and supply report will be created, for internal purposes, to track vehicle mileage, gas along with wear and tear. If there are any concerns with the vehicle or if maintenance is required the vehicle is sent to the fleet garage along with a paper report documenting the concerns. The vehicle is returned to the ambulance service when the repairs or maintenance are completed.

An inventory of the supplies on board the ambulance is taken and a list of the items needed to be replenished is electronically sent to the medical supplies warehouse via EDI for restocking. It is essential that those items are shipped quickly so that the ambulance is prepared for the next emergency.   The ambulance always has reserves on board, but keeping those reserves replenished ensures they will not run out of supplies in an emergency situation.

Requirement: Draw the Process Map for the Hospital Chain Scenario

(Note: 1, Assume that the individual can call for 9‐1‐1 on their own. 2 In assignment we only have to focus on the land ambulance service; sub‐processes for the other services do not need to be elaborated on.)

Answer 1

The process of co-ordinating when ambulance service is being sent out on being called 9-1-1 requires lot of on-board calling and co-ordinating. The strategy adopted includes lot of things that needs to be followed step by step for maintaining hospital chain scenario.

Let us assume that a patient called 9-1-1 and described the situation. If it is an emergency situation, the ambulance is immediately sent out by accessing the location. It starts with the patient calling for emergency and it is certain that immediate care is needed to take care of the health situation of the patient. The HCC speak to the patient and after reviewing, send an emergency ambulance to the location of the patient.

There are series of functions that the ambulance service needs to perform as part of their responsibility.

On-board alert of the ambulance service provider so that the ambulance navigate the location and reach immediately. It includes lot of things for finding the best route like location, condition of weather as well as time.

The ambulance arrives and accesses the patient condition. The patient’s condition is first stabilised if required before carrying in ambulance to hospital.

The patient is picked in the ambulance and according to the location, find the best hospital around suitable for the patient. The ambulance on-board service speaks to the doctors in the hospital to give the patient condition and determines if critical care is needed. Consulting the doctors, they work to stabilize patient’s condition and also identifies if hospital care is needed.

If hospital care is needed, the patient is taken to the hospital or else the ambulance return to their dispatch station and provides a complete report. The ambulance service gives all the information while on the route if the patient is taken to the hospital through on-board calling service.

This helps hospital to complete the preparation part and be ready to help the patient and receives the patient. After the patient is transferred to the hospital, the ambulance service needs to prepare the complete report and submit to the office. The report is completed by the ambulance service about the patient using the on-board service before leaving the hospital and submits also a copy to the hospital.

The ambulance service sends a patient invoice to the e-mail and the cost is mostly around $45. The ambulance also creates a report for the internal official purpose.