NDMS Patient Reception Area Operations Patient Administration & Tracking

1. NDMS Patient ReceptionArea OperationsPatient Administration & Tracking Michael Peters VA EMSHG Area Emergency Manager VA Central Iowa Health Care System Des Moines, Iowa

2. Patient Administration & Tracking • Examples from Des Moines casualty reception operations plans • Excerpts from FCC Guide related to patient administration and tracking (Draft 29Jan04) • Issues & Questions

3. Des Moines Casualty ReceptionPatient Administration & Tracking • Without a system standard to follow, we do what we think will work best in our local situations with available local resources. • CY2003 Operations Plan Review • Shift from a clinical to an administrative focus • Move away from the MCI triage categories • Create a new NDMS patient identification system

4. Shift to an administrative focus … • Move admin to the front of the line. • Rationale: • With the basic planning assumption that in-coming patients are stabilized, the priority becomes tracking and accountability. • If the patient is unstable, they bypass normal reception procedures. • Increasing administrative support on the front end of the reception process will not adversely delay transport to hospitals.

5. Move away from the MCI triage categories … • Sort patients by litter vs. ambulatory status. • Rationale: • With the basic planning assumption that in-coming patients are stabilized, the priority becomes tracking and accountability. • If the patient is unstable, they bypass normal reception procedures. • Increases visibility of litter versus ambulatory transportation requirements.

6. New NDMS patient ID system … • Replace METTAG with a “NDMS patient tracking wristband”. • Rationale: • METTAG is temporary and would not stay with or on the patient after hospital admission. • Patient identification wristband readily identifies an NDMS patient throughout their hospital stay.

7. Des Moines NDMS Patient ID Patient Tracking # 031107-0001 03 = Year 11 = Month 07 = Day Casualty # received that day

8. The New Process: Loading Up The Admin Functional Exercise 11/03 Full Scale Exercise 11/04

9. Following hospital admission … • Validate hospital admission list with PRA tracking worksheets and transportation log. • FCC populates local master patient tracking database (Excel spreadsheet) • FCC receives daily NDMS Patient Status Report from each hospital. • Diagnosis, Condition, Projected LOS, etc. • FCC enters appropriate data into Medical Claims Processing System (MCPS)

10. FCC Guide (Draft 29Jan04) • Patient Administration Excerpts • Guidance + Questions

11. FCC Guide (Draft 29Jan04) • Chapter 1: • Definitive Medical Care: • “FCCs may also coordinate lodging for displaced outpatients evacuated for the purpose of obtaining needed medical care, subject to the authorization and funding provided in the DHS mission assignment.”

12. FCC Guide (Draft 29Jan04) • Chapter 2: • NDMS Definitive Care Requirements Assessment: • Mission Assignments: • “Evacuation and medical treatment for patients directly affected by the disaster, patients in the disaster area needing care no longer available as a result of the disaster or emergency, or patients not affected by the disaster but occupying beds that could be used for admission of disaster victims.”

13. FCC Guide (Draft 29Jan04) • Annex D: Patient Reception Area Plans • Patient Administration: • “The FCC Coordinator assumes administrative responsibility for patients. This responsibility begins upon a patient’s arrival and continues until the patient is either returned home or, in the case of military patients, returned to the responsible Service personnel system …”

14. FCC Guide (Draft 29Jan04) • Annex D: Patient Reception Area Plans • Patient Administration: • “NDMS member hospitals should provide information to the FCC Coordinator, to include a daily admission and disposition list (indicating the expected length of stay) and a narrative summary upon discharge of the patient.”

15. Annex D: Patient Reception Area Plans Patient Administration: “Ensure that the following information is included in the tracking system adopted by the FCC: Patient name SSN Medical Regulating category Type of patient (directly injured, relocated/displaced) Home address (if available) Next of kin (if available) Admitting hospital, admission date Local domicile (hotel or shelter) FCC Guide (Draft 29Jan04)

16. FCC Guide (Draft 29Jan04) • Annex D: Patient Reception Area Plans • Patient Administration: • The PRA Plan should address: • Policies and procedures for disposition of records. • “The FCC Coordinator generally retains patient data for the minimum period required by statutory law. The FCC Director will determine, in conjunction with legal advice, the final disposition of this information. All appropriate patient confidentiality procedures … must be followed.”

17. FCC Guide (Draft 29Jan04) • Annex E: Patient Discharge and Return • Responsibilities: • “Patients requiring continuing health care or observation must be accepted by a physician at their home location prior to being returned.” • “Patients not requiring medical care en route may be provided transportation procured through other channels. The FCC may assist representatives of the DOT (ESF-1) in coordinating the travel of returning patients.”

18. FCC Guide (Draft 29Jan04) • Annex E: Patient Discharge and Return • Returning Patients Requiring En Route Care: • “Confirmation is required from a physician at the destination who is willing to accept and admit the patient …” • “Attending physicians at medical facilities who report patient movement requirements should be prepared to provide as much medical information as possible on patients as is known. Additional reporting requirements may be levied by GPMRC.”

19. FCC Guide (Draft 29Jan04) • Annex E: Patient Discharge and Return • Deceased Patients: • “Civilian disaster victims who expire during evacuation or following admission to an NDMS hospital will be handled in accordance with procedures of the local medical examiner.” • “FCCs may assist in burial arrangements in accordance with the original DHS mission assignment when no legal custodian is identifiable.”

20. Closing … • Many questions remain regarding NDMS patient administrative issues and procedures. • Look for additional guidance as the final FCC Guide is assembled. • Thank you … 