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CAAMS: Summary of progress and potential 1990–1994
SPECIAL COMMUNICATION
CAAMS: Summary of Progress and Potential 1990-1994 Eileen Frazer, RN, Executive Director of the Commission on Accreditation of Air Medical Services
History and Development The Commission on Accreditation of Air Medical Services (CAAMS) celebrated its fourth birthday on July 13, 1994. As a nonprofit corporation, CAAMS became operational in October 1991. The organization spent an intense initial year in developing bylaws and policies and procedures, and in publishing the first edition of accreditation standards that addresses issues of patient care and safety in both fixed and rotor wing. The Commission actually was conceived from the need to demonstrate quality in patient care and safety by air medical professionals. Many in the profession were concerned with the increasing number of emergency medical services accidents along with the quality of patient care rendered without standardization. In the late 1980s, there was also a fear that the air medical profession would become subject to more stringent government regulations or be included in another accrediting agency's realm without the benefit of appropriate input. Therefore, many air medical services supported the concept of developing a specific air medical transport accreditation process. The result: A system more aware of its own realities and needs and more credible in designing appropriate standards. The Commission is an organization of organizations. The Association of Air Medical Services (AAMS) provided the impetus and funding for start-up and joined the following organizations in that initial meeting four years ago to form CAAMS. Members include the American College of Emergency Physicians (ACEP); National Association of Air Medical Communication Specialists (NAACS); National Association of EMS
398
Physicians (NAEMSP); the National EMS Pilots Association (NEMSPA); the National Flight Nurses Association (NFNA); and the National Flight Paramedics Association (NFPA). Since its inception, seven additional organizations have joined the Commission: the American Academy of Pediatrics (AAP); American Association of Respiratory Care (AARC); National Association of Neonatal Nurses (NANN); National Association of State EMS Directors (NASEMSD); Air Medical Physician Association (AMPA); and the National Air Transport Association (NATA). These board representatives are involved with air medical transport in their professional lives and volunteer their time and talents to CAAMS. The board reviews accreditation applications making appropriate accreditation decisions as the final outcome. Not all of the services that have been site surveyed have initially received full accreditation status. Although only the names of accredited services are published, some have been on a deferred status meaning the board needed further clarification, documentation or explanation in order to make an accreditation decision. The other accreditation decisions that can result from a site survey are listed on Table 1. Board members are also active in committee work. A standards committee takes comments for standards revisions. Its goal is to publish standards every two years in order to stay current with our constantly changing profession. The Site Survey Procedures Committee develops and revises appropriate policies that guide the activities and functions of the Commission. The Site Surveyor Selection Committee selects and trains site survey-
ors. The Public Relations Committee addresses marketing issues and the Aviation Advisory Committee meets with aviation experts (representatives from operators, manufacturers and the Federal Aviation Administration) twice a year to discuss our activities and take their input and suggestions. Not only has growth been experienced in the member organizations, but 12 new site surveyors have been added to the original group of site surveyors who were trained in August of 1991. This was made possible by a grant from the National Highway Traffic Safety Administration (NHTSA). The Site Surveyor Education Program was held in January, 1994. Applicants who qualify for site surveyor positions must have four years of air medical experience in two of the three following areas: medical, administration or aviation. Site surveyors also must possess exceptional communication skills in order to serve our constituents in a professional manner.
Site Survey Process There are five steps to accreditation as follows: 1. Write or call Eileen Frazer, Executive Director, P.O. Box 1305, Anderson, SC 29622-1305, (803)287-4177, for a one-page application. 2. Return this application with $300 (initial fee) to receive the Program Information Form (PIF), a comprehensive self-study. 3. Return the completed PIF with 50 percent of the accreditation fee, and your site visit can be scheduled in four to six weeks. The PIF is reviewed by two board members before site surveyors are selected in order to meet the
Air Medical Journal 13:10 October1994
abk
Accreditation
Decisions
Full Accreditation
Withhold Accreditation
An air medical service demonstrates substantial compliance* with the accreditation standards at the time of the site visit. Full accreditation is granted for three years. At the end of this time, the service may request renewed application.
An air medical service has held full accreditation and is no longer considered to be in substantial compliance with accreditation standards.
Probational Accreditation
Provisional Accreditation Provisional accreditation is granted when a program has applied for the first time and has deficiencies which are, in the judgment of the board, easily correctable but prevent the service from being in substantial compliance. Provisional accreditation is temporary and lasts a maximum of six months. Only two further accreditation actions can result at the end of six months: Full accreditation will be awarded if co[qcerns and deficiencies are addressed to the board's satisfaction. Accreditation will be withdrawn if Concerns and deficiencies are not corrected within six months.
An air medical service has held full accreditation and is no longer considered to be in substantial compliance with accreditation standards. There is a two-year interval between reviews for services with probational accreditation.
Withdrawal of Alccreditation An atr medica serVice holding probational or 9rovisional accreditation fails tb demonstrate substantial comottance wttn the accreditation standards ~ 3on follow-up revtew.
*Substantial compliance is defined by the Commission as follows: an air medical service demonstrates overall quality of service consistent with the essential elements of the Accreditation Standards in the professional judgment of the Board. The service demonstrates a steady balance in all dynamic components which comprise their specific program.
unique needs of each service. 4. Site surveyors will visit--a one- to two,day process--and complet e a checklist and summary report for review by the CAAMSBoard. 5. The CAAMSboard will make the final accreditation decision. A service will be notified within 10 days of the board meeting of the accreditation action. The board currently meets four times a year. Cost Justification--Why Be Accredited?
The charge for accreditation varies depending on the complexity of the service, the number of flights, number of aircraft and number of bases. Cost varies from $5,000 to $10,500, about the price of an outside consultant. The Commission has taken several steps to minimize expenses. Despite the increase in airfares over the past year, the cost of a site visit which includes all travel, food and lodging expenses for the site surveyors has not been increased. Site surveyors also receive a fee for the site visit. Paying for accreditation can be justified in the altruistic sense of wanting to improve a service, instilling pride and loyalty among employees and motivating the staff. However, financial incentives also are
Air Medical Journal 13:10 October 1994
realized by increasing efficiency thereby reducing costs and also in using accreditation as a marketing tool. Logos of CAAMS, to be used on the aircraft, stationary and printed materials, are provided to all accredited services.
premiums. All air medical services that have gone through the process definitely believe that accreditation is a benchmark of quality they can display proudly to other air medical professionals. patient referral agencies and the general public.
Potential Incentives
An increasing number of states (Florida, New Mexico. Arizona. Texas. Michigan. Kansas, and Hawaii. for example) are considering using the CAAMS accreditation standards as state guidelines or are accepting CAAMS accreditation in lieu of the state inspection process, which can be a savings in both time and money. In addition, the Commission has recently been contacted by some large health-maintenance organizations that are interested in reviewing the accreditation standards and using the accreditation certification as a reimbursement incentive. The Commission on Accreditation of Air Medical Services continues to communicate with aviation insurers that also are interested in the accreditation standards that have become a barometer of quality for the air medical profession. Some air medical services believe that accreditation will position them for the future in terms of reimbursement and lower insurance
Accredited Air Medical Services Share Their Experiences
The Commission on Accreditation of Air Medical Services continued to show growth in 1993-94 with 18 accredited air medical services. 14 in this fiscal year alone. (See Table 2 for listing of accredited services and Table 3 for growth per fiscal year in initial applications and site visits.) Despite the uncertainty of impending health-care reform and its potentially pervasive impact on the future, the Commission continues to receive initial applications for accreditation because air medical professionals are striving for quality and safe operations. However, some services have delayed sending PIFs which must be completed by a service prior to scheduling the site visit. The reasons for these delays vary but ultimately air medical professionals are apparently apprehen= sive, not only about completing the lengthy PIF but also about the site visit.
399
table CAAMS
Accredited
Services
As of June 30, 1994, 18air medical services have attained full accreditation with an additional 22 paid initial applicants. There have been 14 accreditations awarded in this fiscal year, three in fiscal 1992-93 and one in fiscal 1991-92. The Commission is pleased to recognize the currently accredited air medical services: • LifeFlight MeritOare--Fargo, North Dakata • LifeGuard--Albuquerque, N e w Mexico • U C D M C Life Flight--Sacramento, California • EastCare--Greenville, North Carolina • Medi-Flight of Northern California--Modesto, California • Presbyterian Air AmbulancemAIbuquerque, N e w Mexico • AirEvac for Tulsa--Tulsa, Oklahoma • INTENSIVE AIR ---Sioux Fails, South Dakota
referred back to the accreditation standards. However, there were some elements of dupfication."~--Dottie Tanner,
RN, Chief Flight Nurse of the Air Care Team, Orlando, Fla. 'q-he PIF was time consuming. Flight For Life developed a working committee made up of nurses, pilots, mechanics, clerical and administrative staff to handle the appropriate content related to their area of expertise. Meetings were held monthly, and then weekly, prior t o submitting the self-study.--
"Jodee Trainor, RN, Program Director of Flight For Life, Denver, Colo.
• S K Y M E D - - C o l u m b u s , Ohio • U M C Air CaremTucson, Arizona • Air Care T e a m - - O r l a n d o , Florida • Samaritan AirEvac--Phoenix, Arizona • CareFlightmDayton, Ohio • Air 1--Tyler, Texas • U Mass Life Flight--Worcester, Massachusetts • REACT--Rockford, Illinois • Metro Life Flight, Cleveland, Ohio • Flight for Life, Denver, Colorado
To address these concerns, four program directors from accredited services have shared their experiences with the accreditation process and their feelings about the benefits of accreditation. H o w difficult w a s it to c o m p l e t e the PIF?
"The PIF was difficult and time consuming. However, I didn't really expect anything different. I have participated in numerous accreditation processes in my organization and nearly all required some type of informational text to properly evaluate the organization. I a p p r o a c h e d it as educating others about my program. The PIF is designed to require the applicant to review the standards within their program, as you complete it. In our program, I assigned the ground work to various individuals; for example, researching the different standards and seeking out our documentation of
400
compliance. Policies and procedures were reviewed (revised if necessary) by different members of the program. Safety standards were referred to the Safety Committee. Everyone reported their findings back to me so I could actually complete the PIF. I found that most of the information needed we already had; I just needed to assemble it, or in some cases clarify it. Reports were consistently made to the staff meetings, etc., regarding the progress of the PIF. Although I have heard Comments that the process.is too difficult, I feel the CAAMS process is designed to reflect high standards, not minimum standards. Therefore, I would be less likely to value successful accreditation if the process was an easy one."--
Candy Skidmore, RN, Program Manager of CareFlight, Dayton, Ohio " I did not feel the PIF was difficult to complete since all the questions
"I would suggest doing the entire PIF on the computer. I was able to cut and paste our policies and procedures and plug t h e m into the PIF where requested. I did find some redundancies in the PIF, though. Also, it was difficult to assign a particular section to a pilot or a nurse, for example, because the PIF follows the order of the accreditation standards and there is overlap between the medical and aviation ques-
tions."--Ken Williams, MD, Medical Director of U Mass Life Flight, Worcester, Mass. H o w s t r e s s f u l w a s t h e s i t e visit a n d is t h e r e a n y t h i n g y o u w o u l d d o d i f f e r e n t l y to p r e p a r e f o r t h e s i t e visit?
"There was normal apprehension in anticipation of the site survey, but I don't think there is anything I would have done differently in preparing for the site visit."--Candy Skidmore, RN,
Dayton, Ohio "I recommend calling programs that have already been t h r o u g h the process. That is what we did, and it helped us to prepare for the site visit. The Site Surveyor Team Coordinator is also very helpful since I was able to communicate with him directly and set up the entire interview and tour schedule to meet our scheduling needs and their time frame."--Dottie Tanner, RN,
Orlando, Fla.
Air Medical Journal
13:10 October 1994
'~Fhe site visit was a learning experience and actually valued by all members of the flight team. The surveyors conveyed a true interest in identifying the strengths and growth areas of our program. Information was shared and remedial suggestions were made. Overall, the experience was positive, c o m p r e h e n s i v e and fair."--Jodee
Trainor, RN, Denver, Colo '~here is nothing we would do differently to p r e p a r e for t h e site visit. However, the site surveyors have a tight schedule, with tours and interviews, and I would have preferred that they had more time to observe our
operations."--Ken Williams, MD, Worcester, Mass. W h a t do you feel are t h e b e n e f i t s of a c c r e d i t a t i o n a n d w h a t c h a n g e s h a v e you m a d e as a result of accreditation?
"I feel that accreditation demonstrates a commitment to safety, patient care and high quality. It sends a message about a p r o g r a m in that there is an effort to identify strengths as well as weaknesses, and to focus on improvement. CAAMS is somewhat like a quality improvement project on a larger scale. A d d i t i o n a l l y , a c c r e d i t a t i o n d e m o n s t r a t e s to our customers and regulators that we are a responsible and mature industry. By setting standards high and then striving to meet those standards, we reflect our willingness as an industry to regulate ourselves. Accreditation was a positive experience for m e m b e r s of our prog r a m . T h e p r o g r a m w o r k e d well t o g e t h e r as a team to focus on one goal; recognizing each other for the e x c e l l e n t c o n t r i b u t i o n s e a c h one m a k e s to a c h i e v i n g s t a n d a r d s and working together to improve areas. " A l t h o u g h we d i d n ' t m a k e m a j o r
'.a I Sou n d I "When Vilairway control is manda • Attaches to a standard 15 mm endotracheal tube connector. • Easy to keep the tube directed within the
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Skidmore, RN, Dayton, Ohio "I s e e t h e i m m e d i a t e b e n e f i t s of accreditation as follows: 1) creates a marketable recognition within the community and with other air medical services; 2) instills pride in employees; and 3) positions us for the future in terms of reimbursement.
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changes to our program overall prior to the survey, we did 'clean up' some of the policies and procedures that really needed to be clarified or rewritten. We have just recently received our results (the accreditation letter that outlines the concerns and deficiencies), and so we will m a k e s o m e i m p r o v e m e n t s related to our survey results. This will include increasing security on our helipad and increasing infection-control training for pilots and mechanics. We are also looking at the structure and reporting relationships of our perinatal nurses that accompany us on high-risk o b s t e t r i c i a n transports."--Candy
13:10 October1994
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Table
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Air Medical Journal 13:10 October 1994
"We have made the following changes as a result of accreditation: added new equipment; broadened our initial and recurrent education programs for medical personnel; and m a d e improvem e n t s in our C o n t i n u o u s Q u a l i t y Improvement Process and Utilization Review program."--Dottie Tanner, RN,
Orlando, Fla. "The accreditation process helped us to focus on all operational and safety functions of our program. The selfstudy and the site survey encouraged all staff to critically evaluate how we do our b u s i n e s s . It proved to be v e r y enlightening and, at times, sobering. The benefits are unique to each program, but on behalf of Flight for Life, it has elevated our level of awareness and quality to better meet our mission and serve our patients. The changes made to operational policies, safety
procedures and patient care aspects have all been modified to some extent as a result of the accreditation process. Examples include: 1) a new comprehensive i n c i d e n t / a c c i d e n t plan and procedure that is broader in scope and clarifies role holders, their responsibilities and training components; 2) functional safety features have been added to the helicopter; 3) new signage in the hanger; 4) enhanced operational procedures; and 5) a great emphasis has been placed on the quality and practice expectations of the second patient care p r o f e s s i o n a l . " Jodee Trainor, RN,
and, in a d d i t i o n , we m a d e s o m e changes in our operational policies. Although being accredited does not result in any direct r e i m b u r s e m e n t benefit at this time, I am sure that is coming. We have found that it lends credibility to our service, however, and we have used accreditation in our educational efforts. Also, we derived that it carried some weight when applying to t h e s t a t e D e t e r m i n a t i o n of N e e d p r o c e s s for our s e c o n d aircraft. Overall, it i n c r e a s e d the p r i d e and morale among our air medical personnel and the institution as a whole." Ken
Denver, Colo.--
Williams, MD - Worcester, Mass.--
"As a r e s u l t of t h e a c c r e d i t a t i o n process, we have developed a more comprehensive post incident/accident plan which will be tested in an annual drill. Also, we have looked at the ongoing educational and clinical experiences in obstetrics for the flight nurses
ARADYNE WINDSOCKS
C o m m e n t s from the Commission: The Commission welcomes comments
about the accreditation process and is willing to m a k e a p p r o p r i a t e c h a n g e s when needed. For example, the original PIF format has been completely refor-
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matted to m a k e it as u s e r friendly as possible. T h e new format c o i n c i d e s with the AAMS' data collection format so that AAMS members do not have to collect data in two different ways. In fact, the entire process can be done on c o m p u t e r . T h e P I F is a v a i l a b l e in WordPerfect 5.1 and in ASCII format. All information in the PIF is reviewed thoroughly by two board members and the site surveyors to prepare for the site visit. This is a more cost-effecfive way of providing a comprehensive evaluation
b e c a u s e s i t e s u r v e y o r s a r e a b l e to review material prior to the site visit and focus on the areas requiring more attention. The Commission on Accreditation of Air Medical Services understands there are always g o i n g to be s t r o n g e r and weaker areas within an air medical service. T h e C o m m i s s i o n is l o o k i n g for "substantial compliance" with the accreditation standards not necessarily an affirmative reply to each and every question in the PIF. We define "substantial compli-
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ance" as follows: an air medical service demonstrates overall quality of service consistent with the essential elements of the accreditation standards in the professional judgement of the board. The service demonstrates a steady balance in all dynamic components which comprise their specific program. The Commission is sensitive to the anxiety that can be produced by an outside evaluation team. The site visit is an educational, information-gathering process. The primary role of the site surveyor is a data collector. The Board of Directors makes accreditation decisions. Another important part of the site survey process is the evaluation of the surveyors themselves, which are submitted by the air medical service at the completion of the site visit. Obviously, the four air medical services interviewed felt that they benefitted by the accreditation process. Measurable economic incentives such as decreased insurance premiums and reimbursement benefits probably will not be realized until t h e r e are g r e a t e r n u m b e r s of accredited programs. However, legislators in a growing number of states are beginning to acknowledge the CAAMS accreditation in lieu of state inspections. Ultimately, accreditation represents significant achievement for the air medical services, and the certificate of accreditation is a benchmark of quality to other air medical professionals, patient referral agencies and the general public.
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Air Medical Journal
13:10 October 1994
CAAMS: Summary of Progress and Potential 1990-1994 Eileen Frazer, RN, Executive Director of the Commission on Accreditation of Air Medical Services
History and Development The Commission on Accreditation of Air Medical Services (CAAMS) celebrated its fourth birthday on July 13, 1994. As a nonprofit corporation, CAAMS became operational in October 1991. The organization spent an intense initial year in developing bylaws and policies and procedures, and in publishing the first edition of accreditation standards that addresses issues of patient care and safety in both fixed and rotor wing. The Commission actually was conceived from the need to demonstrate quality in patient care and safety by air medical professionals. Many in the profession were concerned with the increasing number of emergency medical services accidents along with the quality of patient care rendered without standardization. In the late 1980s, there was also a fear that the air medical profession would become subject to more stringent government regulations or be included in another accrediting agency's realm without the benefit of appropriate input. Therefore, many air medical services supported the concept of developing a specific air medical transport accreditation process. The result: A system more aware of its own realities and needs and more credible in designing appropriate standards. The Commission is an organization of organizations. The Association of Air Medical Services (AAMS) provided the impetus and funding for start-up and joined the following organizations in that initial meeting four years ago to form CAAMS. Members include the American College of Emergency Physicians (ACEP); National Association of Air Medical Communication Specialists (NAACS); National Association of EMS
398
Physicians (NAEMSP); the National EMS Pilots Association (NEMSPA); the National Flight Nurses Association (NFNA); and the National Flight Paramedics Association (NFPA). Since its inception, seven additional organizations have joined the Commission: the American Academy of Pediatrics (AAP); American Association of Respiratory Care (AARC); National Association of Neonatal Nurses (NANN); National Association of State EMS Directors (NASEMSD); Air Medical Physician Association (AMPA); and the National Air Transport Association (NATA). These board representatives are involved with air medical transport in their professional lives and volunteer their time and talents to CAAMS. The board reviews accreditation applications making appropriate accreditation decisions as the final outcome. Not all of the services that have been site surveyed have initially received full accreditation status. Although only the names of accredited services are published, some have been on a deferred status meaning the board needed further clarification, documentation or explanation in order to make an accreditation decision. The other accreditation decisions that can result from a site survey are listed on Table 1. Board members are also active in committee work. A standards committee takes comments for standards revisions. Its goal is to publish standards every two years in order to stay current with our constantly changing profession. The Site Survey Procedures Committee develops and revises appropriate policies that guide the activities and functions of the Commission. The Site Surveyor Selection Committee selects and trains site survey-
ors. The Public Relations Committee addresses marketing issues and the Aviation Advisory Committee meets with aviation experts (representatives from operators, manufacturers and the Federal Aviation Administration) twice a year to discuss our activities and take their input and suggestions. Not only has growth been experienced in the member organizations, but 12 new site surveyors have been added to the original group of site surveyors who were trained in August of 1991. This was made possible by a grant from the National Highway Traffic Safety Administration (NHTSA). The Site Surveyor Education Program was held in January, 1994. Applicants who qualify for site surveyor positions must have four years of air medical experience in two of the three following areas: medical, administration or aviation. Site surveyors also must possess exceptional communication skills in order to serve our constituents in a professional manner.
Site Survey Process There are five steps to accreditation as follows: 1. Write or call Eileen Frazer, Executive Director, P.O. Box 1305, Anderson, SC 29622-1305, (803)287-4177, for a one-page application. 2. Return this application with $300 (initial fee) to receive the Program Information Form (PIF), a comprehensive self-study. 3. Return the completed PIF with 50 percent of the accreditation fee, and your site visit can be scheduled in four to six weeks. The PIF is reviewed by two board members before site surveyors are selected in order to meet the
Air Medical Journal 13:10 October1994
abk
Accreditation
Decisions
Full Accreditation
Withhold Accreditation
An air medical service demonstrates substantial compliance* with the accreditation standards at the time of the site visit. Full accreditation is granted for three years. At the end of this time, the service may request renewed application.
An air medical service has held full accreditation and is no longer considered to be in substantial compliance with accreditation standards.
Probational Accreditation
Provisional Accreditation Provisional accreditation is granted when a program has applied for the first time and has deficiencies which are, in the judgment of the board, easily correctable but prevent the service from being in substantial compliance. Provisional accreditation is temporary and lasts a maximum of six months. Only two further accreditation actions can result at the end of six months: Full accreditation will be awarded if co[qcerns and deficiencies are addressed to the board's satisfaction. Accreditation will be withdrawn if Concerns and deficiencies are not corrected within six months.
An air medical service has held full accreditation and is no longer considered to be in substantial compliance with accreditation standards. There is a two-year interval between reviews for services with probational accreditation.
Withdrawal of Alccreditation An atr medica serVice holding probational or 9rovisional accreditation fails tb demonstrate substantial comottance wttn the accreditation standards ~ 3on follow-up revtew.
*Substantial compliance is defined by the Commission as follows: an air medical service demonstrates overall quality of service consistent with the essential elements of the Accreditation Standards in the professional judgment of the Board. The service demonstrates a steady balance in all dynamic components which comprise their specific program.
unique needs of each service. 4. Site surveyors will visit--a one- to two,day process--and complet e a checklist and summary report for review by the CAAMSBoard. 5. The CAAMSboard will make the final accreditation decision. A service will be notified within 10 days of the board meeting of the accreditation action. The board currently meets four times a year. Cost Justification--Why Be Accredited?
The charge for accreditation varies depending on the complexity of the service, the number of flights, number of aircraft and number of bases. Cost varies from $5,000 to $10,500, about the price of an outside consultant. The Commission has taken several steps to minimize expenses. Despite the increase in airfares over the past year, the cost of a site visit which includes all travel, food and lodging expenses for the site surveyors has not been increased. Site surveyors also receive a fee for the site visit. Paying for accreditation can be justified in the altruistic sense of wanting to improve a service, instilling pride and loyalty among employees and motivating the staff. However, financial incentives also are
Air Medical Journal 13:10 October 1994
realized by increasing efficiency thereby reducing costs and also in using accreditation as a marketing tool. Logos of CAAMS, to be used on the aircraft, stationary and printed materials, are provided to all accredited services.
premiums. All air medical services that have gone through the process definitely believe that accreditation is a benchmark of quality they can display proudly to other air medical professionals. patient referral agencies and the general public.
Potential Incentives
An increasing number of states (Florida, New Mexico. Arizona. Texas. Michigan. Kansas, and Hawaii. for example) are considering using the CAAMS accreditation standards as state guidelines or are accepting CAAMS accreditation in lieu of the state inspection process, which can be a savings in both time and money. In addition, the Commission has recently been contacted by some large health-maintenance organizations that are interested in reviewing the accreditation standards and using the accreditation certification as a reimbursement incentive. The Commission on Accreditation of Air Medical Services continues to communicate with aviation insurers that also are interested in the accreditation standards that have become a barometer of quality for the air medical profession. Some air medical services believe that accreditation will position them for the future in terms of reimbursement and lower insurance
Accredited Air Medical Services Share Their Experiences
The Commission on Accreditation of Air Medical Services continued to show growth in 1993-94 with 18 accredited air medical services. 14 in this fiscal year alone. (See Table 2 for listing of accredited services and Table 3 for growth per fiscal year in initial applications and site visits.) Despite the uncertainty of impending health-care reform and its potentially pervasive impact on the future, the Commission continues to receive initial applications for accreditation because air medical professionals are striving for quality and safe operations. However, some services have delayed sending PIFs which must be completed by a service prior to scheduling the site visit. The reasons for these delays vary but ultimately air medical professionals are apparently apprehen= sive, not only about completing the lengthy PIF but also about the site visit.
399
table CAAMS
Accredited
Services
As of June 30, 1994, 18air medical services have attained full accreditation with an additional 22 paid initial applicants. There have been 14 accreditations awarded in this fiscal year, three in fiscal 1992-93 and one in fiscal 1991-92. The Commission is pleased to recognize the currently accredited air medical services: • LifeFlight MeritOare--Fargo, North Dakata • LifeGuard--Albuquerque, N e w Mexico • U C D M C Life Flight--Sacramento, California • EastCare--Greenville, North Carolina • Medi-Flight of Northern California--Modesto, California • Presbyterian Air AmbulancemAIbuquerque, N e w Mexico • AirEvac for Tulsa--Tulsa, Oklahoma • INTENSIVE AIR ---Sioux Fails, South Dakota
referred back to the accreditation standards. However, there were some elements of dupfication."~--Dottie Tanner,
RN, Chief Flight Nurse of the Air Care Team, Orlando, Fla. 'q-he PIF was time consuming. Flight For Life developed a working committee made up of nurses, pilots, mechanics, clerical and administrative staff to handle the appropriate content related to their area of expertise. Meetings were held monthly, and then weekly, prior t o submitting the self-study.--
"Jodee Trainor, RN, Program Director of Flight For Life, Denver, Colo.
• S K Y M E D - - C o l u m b u s , Ohio • U M C Air CaremTucson, Arizona • Air Care T e a m - - O r l a n d o , Florida • Samaritan AirEvac--Phoenix, Arizona • CareFlightmDayton, Ohio • Air 1--Tyler, Texas • U Mass Life Flight--Worcester, Massachusetts • REACT--Rockford, Illinois • Metro Life Flight, Cleveland, Ohio • Flight for Life, Denver, Colorado
To address these concerns, four program directors from accredited services have shared their experiences with the accreditation process and their feelings about the benefits of accreditation. H o w difficult w a s it to c o m p l e t e the PIF?
"The PIF was difficult and time consuming. However, I didn't really expect anything different. I have participated in numerous accreditation processes in my organization and nearly all required some type of informational text to properly evaluate the organization. I a p p r o a c h e d it as educating others about my program. The PIF is designed to require the applicant to review the standards within their program, as you complete it. In our program, I assigned the ground work to various individuals; for example, researching the different standards and seeking out our documentation of
400
compliance. Policies and procedures were reviewed (revised if necessary) by different members of the program. Safety standards were referred to the Safety Committee. Everyone reported their findings back to me so I could actually complete the PIF. I found that most of the information needed we already had; I just needed to assemble it, or in some cases clarify it. Reports were consistently made to the staff meetings, etc., regarding the progress of the PIF. Although I have heard Comments that the process.is too difficult, I feel the CAAMS process is designed to reflect high standards, not minimum standards. Therefore, I would be less likely to value successful accreditation if the process was an easy one."--
Candy Skidmore, RN, Program Manager of CareFlight, Dayton, Ohio " I did not feel the PIF was difficult to complete since all the questions
"I would suggest doing the entire PIF on the computer. I was able to cut and paste our policies and procedures and plug t h e m into the PIF where requested. I did find some redundancies in the PIF, though. Also, it was difficult to assign a particular section to a pilot or a nurse, for example, because the PIF follows the order of the accreditation standards and there is overlap between the medical and aviation ques-
tions."--Ken Williams, MD, Medical Director of U Mass Life Flight, Worcester, Mass. H o w s t r e s s f u l w a s t h e s i t e visit a n d is t h e r e a n y t h i n g y o u w o u l d d o d i f f e r e n t l y to p r e p a r e f o r t h e s i t e visit?
"There was normal apprehension in anticipation of the site survey, but I don't think there is anything I would have done differently in preparing for the site visit."--Candy Skidmore, RN,
Dayton, Ohio "I recommend calling programs that have already been t h r o u g h the process. That is what we did, and it helped us to prepare for the site visit. The Site Surveyor Team Coordinator is also very helpful since I was able to communicate with him directly and set up the entire interview and tour schedule to meet our scheduling needs and their time frame."--Dottie Tanner, RN,
Orlando, Fla.
Air Medical Journal
13:10 October 1994
'~Fhe site visit was a learning experience and actually valued by all members of the flight team. The surveyors conveyed a true interest in identifying the strengths and growth areas of our program. Information was shared and remedial suggestions were made. Overall, the experience was positive, c o m p r e h e n s i v e and fair."--Jodee
Trainor, RN, Denver, Colo '~here is nothing we would do differently to p r e p a r e for t h e site visit. However, the site surveyors have a tight schedule, with tours and interviews, and I would have preferred that they had more time to observe our
operations."--Ken Williams, MD, Worcester, Mass. W h a t do you feel are t h e b e n e f i t s of a c c r e d i t a t i o n a n d w h a t c h a n g e s h a v e you m a d e as a result of accreditation?
"I feel that accreditation demonstrates a commitment to safety, patient care and high quality. It sends a message about a p r o g r a m in that there is an effort to identify strengths as well as weaknesses, and to focus on improvement. CAAMS is somewhat like a quality improvement project on a larger scale. A d d i t i o n a l l y , a c c r e d i t a t i o n d e m o n s t r a t e s to our customers and regulators that we are a responsible and mature industry. By setting standards high and then striving to meet those standards, we reflect our willingness as an industry to regulate ourselves. Accreditation was a positive experience for m e m b e r s of our prog r a m . T h e p r o g r a m w o r k e d well t o g e t h e r as a team to focus on one goal; recognizing each other for the e x c e l l e n t c o n t r i b u t i o n s e a c h one m a k e s to a c h i e v i n g s t a n d a r d s and working together to improve areas. " A l t h o u g h we d i d n ' t m a k e m a j o r
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Skidmore, RN, Dayton, Ohio "I s e e t h e i m m e d i a t e b e n e f i t s of accreditation as follows: 1) creates a marketable recognition within the community and with other air medical services; 2) instills pride in employees; and 3) positions us for the future in terms of reimbursement.
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changes to our program overall prior to the survey, we did 'clean up' some of the policies and procedures that really needed to be clarified or rewritten. We have just recently received our results (the accreditation letter that outlines the concerns and deficiencies), and so we will m a k e s o m e i m p r o v e m e n t s related to our survey results. This will include increasing security on our helipad and increasing infection-control training for pilots and mechanics. We are also looking at the structure and reporting relationships of our perinatal nurses that accompany us on high-risk o b s t e t r i c i a n transports."--Candy
13:10 October1994
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Table
G r o w t h in Initial A p p l i c a t i o n s and Site V i s i t s Per Fiscal Year 17
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Air Medical Journal 13:10 October 1994
"We have made the following changes as a result of accreditation: added new equipment; broadened our initial and recurrent education programs for medical personnel; and m a d e improvem e n t s in our C o n t i n u o u s Q u a l i t y Improvement Process and Utilization Review program."--Dottie Tanner, RN,
Orlando, Fla. "The accreditation process helped us to focus on all operational and safety functions of our program. The selfstudy and the site survey encouraged all staff to critically evaluate how we do our b u s i n e s s . It proved to be v e r y enlightening and, at times, sobering. The benefits are unique to each program, but on behalf of Flight for Life, it has elevated our level of awareness and quality to better meet our mission and serve our patients. The changes made to operational policies, safety
procedures and patient care aspects have all been modified to some extent as a result of the accreditation process. Examples include: 1) a new comprehensive i n c i d e n t / a c c i d e n t plan and procedure that is broader in scope and clarifies role holders, their responsibilities and training components; 2) functional safety features have been added to the helicopter; 3) new signage in the hanger; 4) enhanced operational procedures; and 5) a great emphasis has been placed on the quality and practice expectations of the second patient care p r o f e s s i o n a l . " Jodee Trainor, RN,
and, in a d d i t i o n , we m a d e s o m e changes in our operational policies. Although being accredited does not result in any direct r e i m b u r s e m e n t benefit at this time, I am sure that is coming. We have found that it lends credibility to our service, however, and we have used accreditation in our educational efforts. Also, we derived that it carried some weight when applying to t h e s t a t e D e t e r m i n a t i o n of N e e d p r o c e s s for our s e c o n d aircraft. Overall, it i n c r e a s e d the p r i d e and morale among our air medical personnel and the institution as a whole." Ken
Denver, Colo.--
Williams, MD - Worcester, Mass.--
"As a r e s u l t of t h e a c c r e d i t a t i o n process, we have developed a more comprehensive post incident/accident plan which will be tested in an annual drill. Also, we have looked at the ongoing educational and clinical experiences in obstetrics for the flight nurses
ARADYNE WINDSOCKS
C o m m e n t s from the Commission: The Commission welcomes comments
about the accreditation process and is willing to m a k e a p p r o p r i a t e c h a n g e s when needed. For example, the original PIF format has been completely refor-
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matted to m a k e it as u s e r friendly as possible. T h e new format c o i n c i d e s with the AAMS' data collection format so that AAMS members do not have to collect data in two different ways. In fact, the entire process can be done on c o m p u t e r . T h e P I F is a v a i l a b l e in WordPerfect 5.1 and in ASCII format. All information in the PIF is reviewed thoroughly by two board members and the site surveyors to prepare for the site visit. This is a more cost-effecfive way of providing a comprehensive evaluation
b e c a u s e s i t e s u r v e y o r s a r e a b l e to review material prior to the site visit and focus on the areas requiring more attention. The Commission on Accreditation of Air Medical Services understands there are always g o i n g to be s t r o n g e r and weaker areas within an air medical service. T h e C o m m i s s i o n is l o o k i n g for "substantial compliance" with the accreditation standards not necessarily an affirmative reply to each and every question in the PIF. We define "substantial compli-
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ance" as follows: an air medical service demonstrates overall quality of service consistent with the essential elements of the accreditation standards in the professional judgement of the board. The service demonstrates a steady balance in all dynamic components which comprise their specific program. The Commission is sensitive to the anxiety that can be produced by an outside evaluation team. The site visit is an educational, information-gathering process. The primary role of the site surveyor is a data collector. The Board of Directors makes accreditation decisions. Another important part of the site survey process is the evaluation of the surveyors themselves, which are submitted by the air medical service at the completion of the site visit. Obviously, the four air medical services interviewed felt that they benefitted by the accreditation process. Measurable economic incentives such as decreased insurance premiums and reimbursement benefits probably will not be realized until t h e r e are g r e a t e r n u m b e r s of accredited programs. However, legislators in a growing number of states are beginning to acknowledge the CAAMS accreditation in lieu of state inspections. Ultimately, accreditation represents significant achievement for the air medical services, and the certificate of accreditation is a benchmark of quality to other air medical professionals, patient referral agencies and the general public.
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Air Medical Journal
13:10 October 1994