Regional advisory council improves patient care

SAN ANTONIO ― The Southwest Texas Regional Advisory Council has a mission to deliver the right patient, in the right time to the right place in an area of Texas that is bigger than West Virginia. The STRAC serves 2.4 million people in a 22-county, 26,000 square mile area. The region has 73 EMS provider agencies, 16 PCI Centers, 11 Stroke Centers, and two Level I Trauma Centers.

Eric Epley, executive director, described the innovative STRAC projects with an emphasis on the purpose ― or "why" ― of regional collaboration in a session at the Pinnacle EMS conference.

STRAC coordinates 60 monthly meetings for representatives from every hospital and EMS agency to refine or create systems to improve patient care across the region. Epley refers to the meeting interactions and positive results that come from those meetings as "co-op-petition."

Memorable quotes
Here are three memorable quotes from Epley on the role of the STRAC.

"We want to be the model regional trauma and disaster medical system in the country."

"Why we do things ― coming together and making decisions ― is important."

"Processes are developed through deliberate consensus. Consensus means I may not get what I want, but I will get what I need."

Key Takeaways on improving care across a region
Epley's presentation, part of a Pinnacle power seminar on innovation, focused on the approach of the STRAC to bring together a diverse coalition of health care providers to use process improvement and consensus to improve patient care. Here are the key takeaways for EMS leaders.

• Systems improve care. Where you become sick or injured should not determine whether you live. A system of care equalizes care across a region.
• Systems hardwire processes. Mutual terminology and processes, developed by the caregivers within the system, is the only way to hardwire processes, like transfer of patients from rural hospitals to a level I trauma hospital, into a system.
• System design is deliberate. Development and implementation of process takes time to ensure buy-in among the participants. An EMS Time Out process took 18-months to develop. A Regional blood/body fluids exposure process took 14-months to develop and widely implement.
• System transparency builds trust. Transparency allowed the STRAC to rapidly develop a multiple-phase Ebola virus disease alert patient flow diagram for a broad coalition that had come to trust each other through previous collaborations. The patient flow encompassed pre-arrival, on-scene and EMS/ER.
• System improvement is by people. Technology doesn't solve problems. System-wide problems are solved by people and the solutions are enhanced by available technology. The STRAC brings people involved in problems together, such as transporting patients with mental health emergencies to the emergency department, to identify solutions through consensus.
• Systems solve the underlying problem. Mandatory hospital diversion in the STRAC, triggered by EMS crews waiting for an emergency department bed for more than 20 minutes, doesn't solve the hospital's patient flow problem, but it keeps the problem at the emergency department from getting worse. The STRAC can motivate and facilitate the hospital's solution to the underlying problem of patient flow into and out of the emergency department.

Learn more:

• Epley recommended the TED Talk: How great leaders inspire action to attendees.
• How to improve EMS patient handoffs at the emergency department
• How to use the MIST for an EMS radio or bedside report
• Southwest Texas Regional Advisory Council website

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