Interesting problems with private providers.

[MedBoy]

@IMS2009

Do you know the common law definition of defamation (libel/slander)?
You may wish to consider it in relation to your comments...

FYI,
The benefits of any disposable medical product are documented thoroughly in a number of medical journals, particularly in the United States, and also here in Australia.  With regard to draw sheets/stretcher sheets, disposable have benefits and drawbacks just as non-disp'.  Disposable decrease the risk of allergic/anaphylactic reaction of patients, whereas 'non-disp' obviously have a risk with bleaching agents (sometimes fragrances) becoming allergens.  Patients' also appreciate disposable with the feeling of sterility. 

The regular draw sheet is generally used to slide over the patient, but the disposable can also be used, and may well be predominantly in the future.  There is no difference in strength, and there is always another sheet on the ED barouche.  Hence this is a non-issue.  The patient is pat-slid over and then the disposable removed after (and quite easily), just as the regular one is.  But if there are people who never go to the wards, they would never know that.

Disposable simply costs the private operator more, saves the hospital money (public $ saved), and is better for the patient.  If everyone had the patient in mind, the system would function as we all would like it to.

[crashndash]

and that is the best spin you will ever see on a forum..lol....obviously your State Manager has schooled you well, he was a grand master of the stuff 

[disOrderly]

Yeah, well the staff of the company we were with didn't appear to want to use the sheet to slide. But I think next time they come in I will insist upon the use of the sheet.

[boredmatrix]

I know that this is the way interhospital transfers work - even amongst the private hospitals, but what about those hundreds who get a SAAS ambulance INTO hospital, how do they get home? - in a private?, and if so - who pays?  You also forget that SAAS personnel cannot go past the reception area of a public hospital without causing a demarkation dispute with the orderlies (see todays medical directive that spells out the few times when we can take a patient to/from a public ward).  Many PTS crews would rather go up to the ward, meet the patient and get a proper handover

With regards to this, I believe this issue arose when the government Orderlies were around. They were concerned about losing their jobs (which they did due to their own fault) and decided that ambos couldn't pick up pt's from the ward. However, times have changed and we are now contracted. There were over 100 government Orderlies on staff, there are now approximately 70 and the workload is astronomically bigger than the government days. I believe most of our staff (and I speak for myself and not the company) would prefer it to escort ambos to the wards rather than picking the patient up ourselves for a number of reasons:

-It is quicker for SAAS/companies
-It reduces our workload
-Does not remove nursing staff from ward
-Orderlies are not trained to use the Ferno and are not allowed to lower the stretcher. Most times the patient will be out of bed and as a result, they must be put back into bed, raised and slid or wiggled across which takes more time than lowering the stretcher.

Having said that, I quite enjoy doing these tasks, but on the whole I can see its inefficiencies.

I'll think you'll find a very old and dusty industrial agreement that was forged between two unions many moons ago - which related to ambo's not going up to the wards because it put the jobs of public sector employed orderlies at risk. 

Hospitals fixed that problem by out-sourcing orderlies......

does it need to be re-visited?  Maybe.

How long will it take you to orientate 800+ ambo's to all the major metro hospitals? Not to mention all the metro fringe volunteer crews, and the country crews (like RMTS) who come to town to pick up patients. 

Add to that staff turn-over.  New staff in metro would be no problem. 

how about every new SAAS Volly in the state - how do you fund their day off work and Fuel to drive to town just to do an orientation to a handful of hospitals which they may get to once every 4 months?

anyone want to volunteer for this job?

no - didn't think so.....

[MedBoy]

The ideal would be;
Orderlies accompany the PTS/ATS/Emerg crews to the wards.  This is how it is done in NSW Ambulance.  

The orderlies are great at moving patients, have great spacial reasoning and understand the hospital layout and system better.  Therefore an orderly can accompany the patient on a barouche with the Ambo crews accompanying the patient for a correct handover.  Orderlies should not be left with that responsibility, and I myself do not leave a patient unless they have been fully handed over to the ward, or consultant.

I have received nothing but excellent help from the orderlies, especially @ the RAH, and look forward to working with them constructively.

[crashndash]

NSW Ambulance and hospital system...there's a model to hold up as best practice.... not!

The current system sort of works ok. My only issue is the waste of a crews time waiting in Emerg waiting for a pt to come down. Tying up an emerg truck for 30-40 mins waiting for admin is ridiculous. While space is at a premium we all know, a holding area needs to be found so that when pts are booked, they can be there waiting when we arrive. We have suggested previously that if the pt doesnt arrive in 20 mins from our arrival, we will clear and return and the pt can be re-booked. Now that we are all part of the one happy (health) family, then it cant be too hard to find a solution for all

[MedBoy]

Every ambulance system, and hospital system has issues.  NSW ambulance does a lot of things very well, and some things not so...don't forget population density, traffic, and admission rate are 'generally' higher in & around Sydney's major hospitals.  If you have ever seen St Vincent's ED on a weekend, it is amazing, 11 crews waiting in the corridor just to get beds, a lot of the time more, 11 cars!

I am in no way criticising SAAS, it is such a large system, and it does very well.  SAAS and the crews have been cooperative and friendly in all encounters.

Following on...if the patients are not ready, there isn't much that can be done.  I just find in that going to the wards that the patients seem to be ready much more quickly for Tx, they make a special effort to clear.  If they think all SAAS crews are out on Emerg jobs, or in Tx, they will not increase their throughput as the patient has nowhere to go.

A holding area is a great idea, push as hard as you all can to get it in the new hospital when it is built.

[disOrderly]

The only issue with a holding area is the fact that the patient needs to be watched. Then we have jurisdiction issues, which nursing staff are the most appropriate to supervise patients? The ward nurse who knows the patient is most appropriate, but then you are keeping a ward nurse off the ward and you will also have a nurse standing around for every single patient. Then who is appropriate? And when are you meant to get a hand over and from whom?

We have had issues like this, for example a patient was brought to us on the wrong day for an appointment. The SAAS crew had already left and the particular OPD refused to observe the pt until another crew arrived to pick the pt up. ED refused to look after a patient that wasn't theirs, and rightly so.

I still think that orderlies escorting ambulance personnel is the best option. That way the attending ambo can get a handover from the nurse while the orderly and the other ambo get the pt ready with the nursing staff.

[MedBoy]

@disOrderly

Promote that person!

[para1]

This is beginning to be a bitch fest again. Since the private providers have started to do Patient transfers it has not made any difference to SAAS ATS workload according to an ATS officer that I know. So stop your bitching and just accept the help.

[boredmatrix]

correct...no noticable difference what-so-ever

there is a place for both. Just so long as the dodgy one of the two companies lifts its game....

[crashndash]

correct...no noticable difference what-so-ever

there is a place for both. Just so long as the dodgy one of the two companies lifts its game....

  hahahahahah...great work Boredy

[disOrderly]

That did make me laugh too haha

[MedBoy]

SO which one is dodgey?

[boredmatrix]

despite popular belief- i'm not into casting asperions.

each may have issues- as to whether they're operational or relate to business management.....i'm sure it will all come out in the wash.....

Time will only tell what will work.

[2468]

So who's looking to get sued and lose their house?

[amboman69]

What about the single operator ambulance that turned up at the RAH today, unloaded the patient and proceeded to the orderlies.

Orderly gowned up because the patient was VRE and transferred the patient.  Private ambo went to hang up the patslide and was told it needed to be wiped down - orderly received strange look from Mr P.A.

Private Ambo was then called away to another job, grabbed the stretcher, - no clean or even so much as a a brief wipe down - just a fresh sheet on top and off he went.

Swell

[MedBoy]

Mr Amboman69,

Be weary.  It is hard to see the full picture from the confines of a chair in the ED.  You seem to know a lot about the patient and the P.A. for someone who should be either looking after their own patient, or clearing for the next job from dispatch.

Everybody makes mistakes, on occasion.  No one ever hears about the SAAS ones though, only private. There are things you perceive to be mistakes, when maybe it is done differently elsewhere...stick to patient care.

[boredmatrix]

 There are things you perceive to be mistakes, when maybe it is done differently elsewhere...stick to patient care.

It doesn't matter whether you work public or private sector-  infection control shouldn't be 'done differently' as you so eloquently put it.

Best practice infection control IS patient care!

perhaps someone needs to find their policy and get a little education on best practice infection control!

If said policy can't be found then perhaps that person should be asking questions!



 

[RubberChicken]

Be weary.  It is hard to see the full picture from the confines of a chair in the ED.  

Is it also hard to see full picture from the confines of a chair being the front seat of your Ambulance as a single operator monitoring your patient via a camera?     - NOTE - Remainder of my comment RETRACTED.

Thanks Crash ... I actually had to revisit my comment after I had completed a little wiki-investigation around the country and to my surprise found that single operator ambulances are widespread - Victoria and New South Wales Ambulance Service (country only).  This before Medboy gets all wiki-legal.

How can this be?  Note the NSW Ambo Union are lobbying to cease this practice.   

I then had a little read of the Non-Emergency Patient Transport Regulations and Clinical Practice Guidelines (Dept of Human Services Victoria) and then fell of my perch.. In Victoria they (being the SA Health equivalent) are happy for a Cert III Patient Transport Officer to act as a single operator in an 'Ambulance'.... even with TWO stretchers/patients in the back of the Ambulance? WHATTHA

[crashndash]

If SAAS as the agency overseeing these things (on Healths behalf) is happy with single operator strecher transfer cases, then its all a moot point Rubbs. Sadly, operators will always scew up, I've seen similar things happen with SAAS crews in the bay at the RAH several times (and worse).

Remembering that AIMS is the Health SA wide system for reporting clinical and systemic issues, feel free to make your observations known to them officially (yes it can be anonymous) - but if you don't, you're just adding to the issue - your choice 

Just in case you feel the courage of your convictions - the number is 1800 668 439

[amboman69]

Actually the incident WAS reported to AIMS - who said that they have had similar reports over the last few weeks (didn't say whether they were SAAS or privates).

And yep - SAAS personnel do the same (and worse), I guess the difference is that at least SAAS has specific guidelines regarding (VRE) infection control, we all know what these rules are - and it is up to us ambos to follow them. The poor soul I was talking about gave the impression that he thought VRE stood for "Very Recent Enema". - it was all a little embarrassing.

And no medboy, I was not watching from the comfort of a chair, neglecting my own patient or slacking off avoiding my next job - I was actually waiting for my patient to come down from the ward and started walking over to give the guy a hand to shift his patient.

It all comes down to professionalism and whether you would be happy for your elderly immuno-suppressed grandma with the leg ulcers to be the next person to lay on that stretcher.

[boredmatrix]

Actually the incident WAS reported to AIMS - who said that they have had similar reports over the last few weeks (didn't say whether they were SAAS or privates).

great work right there from AIMS....

Confidential incident reporting my aunt fanny....

[MedBoy]

Maybe speak to the orderlies first, and if you are going to report something, listen to the whole thing first.  The said incident was reported to PMS management at the time it happened.  The only reason for this being that the P.A. wanted to clean the pat-slide, and the orderly said, "don't worry, leave it outside against the wall, and I will fix it ASAP".  The said P.A. did in fact clean the stretcher, our cleaning products are in our vehicles, we aren't able to have a cabinet or locker like SAAS, and we don't want to use hospital products, so it has to be done outside.

Make sure you look at the whole chain-of-events and not a snapshot.  I am sure the orderly in question will be happy to clarify the situation.

[First Care 1]

Hi All

I have watched this forum with some concern over the past few months, and while most discussion is harmless and in the spirt of the forum I now feel that the line has been crossed for the last time and wish to set the record straight.

First Care Medical is not and has no interest in Ambulance work or becoming an ambulance service provider.Despite being named as such multiple time on this site.

Nor do we engage in anonymous comments on forums such as this, such acts are not what we are about and nor do we have the time for such nonsense.

Medboy

Be very careful with naming companies when you hide behind a very thin veil of anonymity.

Your naming of First Care Medical as a party to some sort of slander is liable and slanderous in its own right, considering you accuse rather than provide proof of such acts.

This is to be considered a not so friendly warning.

First Care Medical will not tolerate slander or unsubstantiated comments regarding its business or staff and will follow all such comments from now on through the appropriate legal channels as well as those of the moderator.

Copies of this site have been made and also reported to the moderator.

David Funnell
Director
First Care Medical