Dirty Wet Wipes, Millions of Dollars, and the Coming Changes to EMS

It was quickly turning out to be one of those mornings. The ER was hopping and everyone was busy. We had been taking in a lot of ambulances since the start of the day shift and everyone was trying to muddle through the increasing patient load. While I was in-between tasks, I noticed that one of the nurses had left a backboard in the hallway outside of a patient room. I figured that I had a few spare moments and took it out to the ambulance garage to clean it and throw it in the cabinet. A mundane task wrapped up into a hectic day.

I have to tell you that I wrote and rewrote that first paragraph four times because I couldn’t seem to write it in a way where it sounds interesting. Cleaning a backboard in an ER isn’t all that exciting, right? Why would I write about something like that?

Because after I wiped the board down with the disinfectant towelettes, I was absolutely horrified with what I found.

The handful of disinfectant wipes I used to wipe the thing off with came out filthy. They were mostly black but were speckled with orange-ish brown spots that come from wiping up drops of blood. The board looked a tad dirty when I started and even smelled faintly of pee but I never expected it to be as dirty as it was. It was absolutely disgusting. What makes it all the worse is that there was no way the blood, dirt, and pee came from the patient who was most recently put on the board. That patient wasn’t bleeding, hadn’t peed, and was well dressed from a clean environment. The patient had been placed on this festering petri-dish of a medical tool by the (hopefully) well-meaning ambulance crew who had responded to the call for help. They had put her on this thing and happily whisked her off to the ER for treatment.

So why, you ask, is this important enough for me to write about. Why would I write about one single backboard carrying one single patient brought in by a small ambulance service to a small hospital? Why is that worthy of wider attention?

I’ll tell you why:  This one incident epitomizes a coming tsunami of liability, headaches, and hardship for EMS providers around the US that is going to completely blind-side EMS. A few years back the Centers for Medicare and Medicaid (CMS) quietly stopped paying for things considered to be “preventable medical errors” including hospital acquired infections. They believed that they could save substantial amounts of money by not paying for injuries and illness caused by the hospitals that were treating the patients they were financially responsible for. You might have guessed that Healthcare Acquired Infections (HAIs) happen to be the largest group of these preventable medical errors and hospitals have gone in to full battle mode to combat them.

It is estimated that one in twenty patients will contract a HAI during their hospital stay. It is also estimated that around 98,000 patients die each year from them. HAIs are the most common complication in hospital care of patients costing the US healthcare system around $45 Billion annually.

Hospitals have to take care of patients who contract HAIs in their facility; they’re just not paid to do it. There are estimates out there that say it costs an individual hospital between $10,000 and $25,000 (or more) for every instance of an individual patient contracting a HAI while in their facility. That’s not small change and hospitals are spending money like crazy to fight germs. Infection control departments are being fully staffed and well-funded, housekeeping and environmental services workers are sitting through hours upon hours of training, policies and procedures for cleaning and disposing of potentially contaminated items are being written and enforced by the truckload and they’re just getting started.

And we in EMS are largely oblivious to this fact.

Think of this. If this patient would have been admitted and found to have a HAI, who would have been at fault? Think hard, because tens of thousands of dollars are on the line per each individual patient. Is it the hospital, which has an army of environmental services staff, a battalion of infection control nurses roaming the hallways, and a forest of policies and procedures in place regarding meticulous cleaning practices? Or the EMS agency that brought in a patient on the backboard that was as clean as those wet wipes showed us it was?

To my knowledge, no hospital in the United States has ever sued an ambulance service or otherwise attempted to collect from one due to non-payment related to a HAI. But it’s coming. It’s coming sooner than you think it will come and if you’re not ready it will blind-side you and potentially bankrupt your service. If you think that I’m mistaken, fine… however when Millions of dollars are on the table locally and Billions are on the table nationally… I don’t think that I am.

Clean your stuff. Wash your hands. Write policies regarding cleaning and infection control, enforce them, and document their continuous use. It’s not a small issue. This is one of those things where EMS must act now or someone will act for us.

Oh, and on that note, have you heard about Medicare’s new concept of paying for patient outcomes? This is where hospitals that have better results for their patient care will get more money than hospitals that have poorer results for their patient care? That’s coming too. What do you think it will do to ambulance services when the hospitals start to identify services that consistently bring in patients who do poorly as opposed to services who consistently bring in patients who do better? Right now, nobody knows… but that issue is coming too. Believe me, the hospitals are tracking it. It’s time to get to work.

Here’s some light reading for you as well as my references.

http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf – CDC analysis paper on cost of HAIs and benefits of prevention.

http://www.huffingtonpost.com/glenn-d-braunstein-md/hospital-acquired-infections_b_1422371.html – Good article with statistics from about hand-hygiene

http://www.medicalnewstoday.com/articles/80074.php – Medicare to stop paying for HAIs

http://www.hfma.org/Templates/InteriorMaster.aspx?id=22142 – Article about pay-for-performance and pay for patient outcomes

  • http://www.facebook.com/profile.php?id=1088829873 Skip Kirkwood

    What a great post! Thanks!

  • 1835wayne

    EXCELLENT post!! Good to see you back!

  • Deb

    This has been an ongoing problem at most services I have worked at. The EMT’s AND the medics don’t think cleanliness is important. I always have enemies at any station because I INSIST that everything be cleaned after EVERY call. Nobody wants to do it. I have taken equipment back out of shelves, pulled the cot out of the truck, had to change “clean” sheets from the cot. I amtired of arguing with nearly everyone about this. Now, I just do it myself, and tell the offender that I hope the ambulance that carries their next family member does things the way they have been doing them. They all agree that they want stuff to be clean and germ free for them and their families, they just don’t want to be the ones to do it. I have offended most at crew quarters also, for cleaning. Just slopping some dirty water on the floor doesn’t constitute mopping. I can’t keep up with all aspects of crew quarters, but I do keep my area clean. I can’t seem to make them understand that we walk in some nasty places, then walk in our “house”, and bring all that back with us. I agree that EMS as a rule will be held accountable in the future. And I understand why. We should already be as clean as possible, just to protect ourselves and our families. Now, more than ever, to protect our jobs!!!

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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  • Comments
    Steel City Medic
    Welcome to the Club
    Particularly appropriate for me this week. Thanks.
    2014-09-23 21:46:00
    DiverMedic
    Welcome to the Club
    Very well done, Chris.
    2014-09-17 22:15:00
    DiverMedic
    My Blogroll
    One of these days you'll figure out where my blog is... :)
    2014-09-17 22:11:00
    emtterri123
    Six Tricks You Can Use Today to Improve Your EMS Narrative Report
    The first and best way to get people reading you to think that you are an idiot is to pepper your writing with spelling and grammatical errors. It makes you look dumb. - Me thinks this should have been restructured as it does not flow and caused me to reread it several times. lol :)
    2014-09-17 08:27:00
    Алексей Рукин
    So You Think You Can EKG?
    78% accuracy... and I'm not even a medical student, only a blog reader...
    2014-07-12 18:12:00

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