Situational Analysis

Integration and creating systemwide solutions to increase efficiency, accountability and patient satisfaction are trends seen across the healthcare industry. Priority Ambulance aligned itself with Baptist Memorial Health Care, which was on the forefront of creating centralized transfer centers and telemedicine strategies to develop an innovative, integrated ambulance service solution. The scale of the integration with the operations and communications center with Baptist patient transfer center, the level of partnership developed between BMHCC and Priority Ambulance and the timeline in which it was implemented show innovation and leadership in the ambulance service industry.

Baptist Memorial Health Care is a not-for-profit hospital network in Mississippi, Tennessee and Arkansas. The system involves 21 hospitals and six communities that Baptist served with 9-1-1 ambulance response. The system was served in some areas by hospital-based ambulance service owned and operated by the hospital system and in some areas by private EMS agreements with various companies. The fragmentation of the ambulance service created inefficiencies within the system and did not lend itself to the level of accountability for its contractors that a sole provider would allow for.

Baptist Memorial Healthcare made great strides beginning in 2015 to centralize patient transfers in BMHCC’s 2,700 beds by developing a Patient Placement Center, which used Teletracking technology to find an accepting physician and bed at the new facility with one phone call. The Teletracking system also provides better data and insight into patient movement throughout the system. The Patient Placement Center was implemented throughout the hospital network in 2016. At this time, Priority Ambulance began the planning phases to continue the integration of the hospital system to include the ambulance service within the Patient Placement Center. BMHCC had created an innovative system of patient placement center management and Priority Ambulance felt we could develop an equally innovative system to address ambulance service throughout their service area.

Goals

In 2016, Priority Ambulance and Baptist began discussions to define the improvements for movement of patients needing a higher level of care located at smaller regional locations across three states with the ultimate goal of patient delivery at the right place at the right time keeping the patient as close to home as possible. Baptist was able to leverage Priority Ambulance’s management expertise, its national purchasing power and the administration efficiencies it experiences as a large national ambulance company to improve care and efficiency for patients during medical transport. This partnership allowed Baptist to laser focus its attention on patient care and hospital operations while holding Priority Ambulance accountable for patient care and experience during transfers and medical transport.

Another key objective of the implementation project was to leverage the vehicles for brand awareness across the established system footprint. To that end, Priority Ambulance created a new subsidiary, Baptist Ambulance, a member of the Priority family of companies that operates with ambulances under Baptist name and logo.

A final goal was to improve patient flow efficiency through transportation. This was accomplished through the integration of Priority Ambulance’s dispatch center with Baptist’s bed management system/transfer center at the Patient Placement Center (PPC). The PPC is staffed with experienced registered nurses that track the status and manage all 2,700 hospital beds in the Baptist system while facilitating transfers and assignments of beds from all 21 Baptist hospitals from one central location. In addition, nurses can assist with air launch for a critical case. This is accomplished via the TeleTracking Technology Transfer Center system.

By co-locating its dispatch center in this facility, Priority Ambulance added ambulance transport to the functions of the PPC’s capabilities in the areas it serves further enhancing and aligning all mission critical services for safe, effective patient movement among Baptist hospitals, and upon discharge to post–acute levels of care. Adding ambulance to the range of service provided by the integrated health system helped assure consistency in the quality and continuum of care for the patient across all hospitals in the system.

In summary, our overall goals were to:

• Improve transportation logistics and patient capture with right place, right time
• Leverage brand equity
• Improve patient flowtime efficiency through transportation

Planning & Implementation

Priority Ambulance met with Baptist Memorial Health Care over the course of 2016 to refine the master services agreement and develop the foundation for the innovative partnership. Ultimately, the master services agreement was signed in March 2017 when another private EMS provider that was serving the Memphis market abruptly left the system leaving Baptist without sufficient ambulance services for patients at its flagship hospital. Priority Ambulance was poised to immediately step in to begin implementation of the sole provider relationships.

Less than a month later, 10 Baptist-branded ambulances were ordered, built, customized and delivered to the Memphis market to begin serving the area. Priority Ambulance hired and onboarded 60 employees in the Memphis market. All training was conducted jointly with hospital leadership and ambulance service leadership. On April 1, 2017, Baptist Ambulance went live starting in the Memphis area.

On May 1, Priority Ambulance began operating a specially customized pediatric critical care unit to serve the Spence and Becky Wilson Children’s Hospital. Priority Ambulance worked with Baptist Children’s on the design and build of the custom ambulance.

On July 24, the Centralized Dispatch Center was created which was co-located with the Baptist Patient Center. Now through one phone call, a referring facility would identify a receiving physician, bed and order ambulance with one phone call. This significantly increased efficiencies among hospital transfers, as well as consolidated medical transportation data for the full Baptist Memorial Healthcare system, which had been fragmented before. The consolidation and analysis of the full system has allowed BMHCC and Priority Ambulance to identify areas of improvement in efficiency and customer service.

Over the course of 2017, Baptist Ambulance completed seven additional integrations through BMHCC’s three-state footprint, which included either cold startups or the purchase of assets and transition of staff to the new management system. All patient transfers and 9-1-1 calls route through the centralized dispatch center.

The full integration schedule was as follows:

• Baptist Memorial Hospital-Memphis – April 1
• Spence and Becky Wilson Children’s Hospital – May 1
• Baptist Hospital-Booneville (and Prentiss County 9-1-1) – June 1
• Baptist Hospital-Calhoun (and Calhoun County 9-1-1) – August 1
• Baptist Hospital-Union County (and Union County 9-1-1) – August 15
• Baptist Hospital-Huntingdon (and Carroll County 9-1-1) – September 24
• Baptist Hospital-Oxford (and Lafayette County 9-1-1) – October 8
• Baptist Hospital-Union City (and Union City 9-1-1) – October 22

One year into the relationship, Priority Ambulance has 31 vehicles and 300 ambulance employees providing medical transport to more than 30,000 patients each year at 12 Baptist Memorial Health Care hospitals and other facilities and provides six communities with 9-1-1 service in Mississippi and West Tennessee. All patient transfer calls and 9-1-1 calls flow through the centralized dispatch center located within the BMHCC headquarters building in Memphis, Tennessee.

As BMHCC continues to grow, Priority Ambulance is a partner in that planning ensuring that ambulance service is covered in every new hospital or expansion opportunity.

Results

The unique partnership between BMHCC and Priority Ambulance has made great progress toward accomplishing the goals set out for the system in a little more than a year of operation.

Goal 1: Improve transportation logistics and patient capture with right place, right time.

The integration of system-wide the Patient Placement Center and ambulance dispatch was one of the first in the country and has impacted patient movement throughout the hospital network and communities where Baptist provides 9-1-1 service. In Booneville, Mississippi, streamlined communication between the 9-1-1 communications center and hospital system resulted in a 64.2 percent increase in average monthly 9-1-1 transports to the closest emergency department at Baptist Memorial Hospital-Booneville. This was achieved through appropriate resourcing and staffing to improve hospital throughput and . Additionally, Baptist Hospital-Union City in Tennessee experience a 9.1 percent increase in monthly average emergency department arrivals via ambulance.

Additionally, Priority Ambulance has been able to increase transfer volume by approximately 40 percent in Memphis since assuming operations in April 2017, and that upward trend has been mirrored at facilities across Baptist’s system. In the total system from the 4th quarter of 2017 when the entire system was first fully implemented to the second quarter of 2018, Priority Ambulance has increased the quarterly number of medical transports at BMHCC facilities by 11.9 percent.

Goal 2: Leverage brand equity.

One of the main goals was to leverage BMHCC’s current brand equity in the market and create a cohesive patient experience in the continuum of care from the time they entered the system by ambulance to being discharged from a Baptist facility. Through creative problem-solving, Priority Ambulance licensed the name and logo from Baptist Memorial Health Care to provide service to its patients and communities using Baptist-branded vehicles and with staff members wearing Baptist-branded uniforms. In addition to building brand equity and good will with the community under the Baptist name, the co-branding of the ambulance service and its hospital partner create a strong sense of connection among the hospital staff and ambulance staff. Both groups are part of the Baptist team working together to provide the best possible care to patients. It’s a team effort, and we all wear the same logo on our uniform to signify that commitment.

Goal 3: Improve patient flow time efficiency through transportation.

Approximately 6,000 calls a month now route through the Priority-staffed ambulance dispatch center. That’s a total of more than 72,000 calls annually routed through the Centralized Dispatch Center. This number includes patient transfers coming in through the BMHCC Patient Placement Center, as well as 9-1-1 calls working in coordination with the local emergency 9-1-1 departments in the communities that we serve. Patient throughput and efficiency were significantly increased through this partnership.

Through integration and better partnership, Priority Ambulance has been able to provide significant value additions to Baptist Memorial Health Care, including implementing ProQA technology and training in its dispatch system, implementing computer automated dispatch (CAD) systems in the county 9-1-1 centers, and utilizing system status management and deployment strategy to improve on-time performance for Baptist hospitals and the communities served. Through teamwork, Baptist and Priority continually look for new, innovative ways that patient experience and care can be improved through integration.

Impact

While integration to increase efficiency is not a new concept in the ambulance industry or the health care industry as a whole, the degree to which Priority Ambulance and BMHCC have integrated operations and the full co-location and integration of the patient transfer center and ambulance dispatch center is innovative in the industry.

Our planning, implementation and operation of the Baptist system provides an excellent case study about the benefits of complete integration with a hospital partner through co-located centralized dispatch and patient transfer center, a shared branding, name and training programs and treating the hospital system as a complete EMS system to best allocate resources and staffing. The patients of Baptist Memorial Health Care are seeing benefits from this integration through improved response times and on-time performance that allows them more immediate access to care. To our knowledge, this is the first integration of this size and scope, and we feel this will be a successful model for Priority Ambulance and the industry.

The benefits of this relationship can be clearly seen in the results section of this nomination and include the following:

• Increased medical transports due to better, more efficient hospital throughput (40% increase in Memphis; 12.9% increase systemwide)
• Further reduced transfer hold times through the patient transfer center
• Increased transports to emergency department due to better resource allocation and staffing plans (64% increase in Booneville, Mississippi; 11.9% average increase in hospitals outside Memphis)
• Increased accountability by having one provider reporting regularly reporting performance to a board of directors
• Improved 9-1-1 response times in every community served with 9-1-1 due to better deployment planning and analysis
• Increased cooperation between hospital and ambulance service due to shared vision and values, branding and logo

Budget

Priority Ambulance invested $1.8 million in vehicles alone for 18 Baptist-branded ambulances to serve the Memphis community and additional capital funds to purchase the additional fleet to serve the remainder of the hospital network. In total, Priority Ambulance invested more than $3 million in ambulance equipment to serve the BMHCC contract.

Additionally, Priority Ambulance invested in the communications infrastructure at Baptist. Priority Ambulance provided CAD systems for the county emergency 9-1-1 centers in the communities that Baptist serves with 9-1-1 – an investment with a value of $150,000 per installation. Priority Ambulance installed and trained all communications employees on ProQA, an investment of $57,000.

These costs were involved in the initial startup investment of the Baptist Ambulance system, which has an ongoing operational and training budget.

Files: Baptist Leader blog Priority Ambulance One Year Celebration.pdf, Commercial Appeal Priority Ambulance Baptist partnership.pdf, Delivering Innovation to Baptist EMS Strong Blog.pdf, Oxford Eagle Baptist Priority Ambulance relationship.pdf