Audrey Fraizer

Audrey Fraizer

Story Vault

By Audrey Fraizer

April 15 has a way of stressing out Americans or, at least, making them a bit on edge. As you know, April 15 is that day your federal tax return must be postmarked and in the mail. Dates past the postmark deadline can add penalties to what might be an already onerous payment due.

April 15, however, also holds a different meaning, albeit a positive one, for Regional Emergency Medical Services Authority (REMSA), Reno, Nev. On that day, the REMSA communication center went down in International Academies of Emergency Dispatch (IAED) history as the first Accredited Center of Excellence (ACE) for the Emergency Communication Nurse System (ECNS).

Not about being first

Similar to tax day, Elaine Messerli, Registered Nurse, REMSA, Clinical Operations Manager Community Health Program, had set a deadline for achieving an ACE for the protocol-based nurse triage system that provides alternative referral options to callers with non-life-threatening symptoms.

The deadline, however, had nothing to do with achieving ECNS accreditation before any other agency, Messerli said.

“Sure, it was an honor to be first, and I had heard that we might be first,” she said. “But that wasn’t our goal. Our goal was accreditation and within the time of our grant. Once we started getting close to submitting our information, the momentum was there and we knew we were the first ECNS users to submit.”

REMSA was awarded a $9.8 million Health Care Innovation (HCI) Award in 2012 from the U.S. Department of Health and Human Services (HHS) to develop a program that would respond to lower acuity and chronic disease conditions in urban, suburban, and rural areas of Washoe County. Outcomes included reducing unnecessary ambulance transports and reducing unnecessary visits and hospital admissions and readmissions while, at the same time, improving patients’ health care experiences and saving costs and providing jobs. It had to be community-centered.

The Centers for Medicaid and Medicare Services (CMS) administered the award for a three-prong approach featuring a Nurse Health Line—coupled with ECNS—and community paramedicine and ambulance transport alternatives.

Similar to all grants, fulfilling the requirements took data collection, proven quality performance measures, and reaching (if not exceeding) objectives. ECNS provides real-time evidence through use of the LowCode software, which integrates with ProQA, to triage the caller’s/patient’s symptoms, provide further assessment, and determine the level of care appropriate for that patient.

Secondly, as Messerli explained, REMSA is accreditation-oriented. Every department within the organization is tasked with attaining performance bars specific to the operation.

“ACE fit into what the grant required and what REMSA expects,” she said. “Being first was icing on the cake.”

An ACE stamp of approval on the innovative approach also speaks to health care policymakers, Messerli said.

“An ACE is part of the strategy to make sure this is sustainable,” she said. “The success of a program can keep it alive because others will follow the lead.”

To achieve accreditation, Messerli put together a small team—the center’s CQI Coordinator who audits calls and gives feedback to the nurses, and an administrative assistant who downloaded data into the Academy’s online system. Other REMSA team members were pulled into the team to collect essential information and data specific to the Twenty Points of Accreditation as well as set goals and deadlines. She also met well in advance with IAED Associate Director Carlynn Page.

Page attributes their success to the center’s foundation, resolve, and leadership.

“ACE is all about compliance and about the structure behind it, and REMSA is an agency that excels,” she said.

The Twenty Points for the fire, police, medical, and nurse triage protocols are consistent, with one exception: An agency using ECNS must have a process in place for the Emergency Communication Nurse (ECN) to send calls back to the Emergency Medical Dispatcher (EMD) if the condition escalates and emergency dispatch (ambulance) is necessary.

REMSA reports quarterly data as part of the HCI Award project.