Audit: EMS provides quality care but medics cite fatigue

Sept. 26--A newly published city audit has found that Austin-Travis County EMS provides quality patient care but that some medics have reported they are increasingly fatigued at work without enough time to rest between shifts.

Excessive fatigue could impair performance, compromise care and slow down response times, according to the audit, which was presented Wednesday to a handful of City Council members.

Surveyed medics reported that fatigue caused them to feel drowsy while driving, decreased their focus, and caused sleep deprivation, anger, frustration and a decreased desire to attend work, according to the audit. Meanwhile, comparable EMS providers in other cities generally have shorter work weeks than Austin-Travis County EMS.

Medics must work 48 hours plus overtime and on-call hours, the audit says, and work shifts have varying hours per day, a schedule that surveyed medics said leads to excessive fatigue and doesn't allow them to recuperate.

EMS director Ernie Rodriguez said that medic schedules were shortened from 56 hours in 2006 but that the agency needs to consider a 42-hour work week to address fatigue concerns. However, he said, such a change could be costly and would require the agency to hire more medics. Other efforts to hone healthier sleep patterns among medics are under way, Rodriguez said, including teaching them "sleep hygiene" and conducting a survey of about 250 paramedics to study their behavioral health.

Much of the discussion between EMS leaders and council members Wednesday centered on how EMS provides patient cares and at what cost to the city.

Nearly 90 percent of 136 medical personnel working at six area hospitals said Austin-Travis County medics provide above average to exceptional care compared with other EMS providers.

Auditors also found that a policy that lets patients choose which hospitals they go to increases the organization's operational costs and may lead to periods where ambulances are unavailable to respond to higher-priority calls. Medics generally take low-priority patients to their preferred facility even when another acceptable facility is closer, the audit says.

Looking at a sample of 59 times medics took patients to facilities, auditors found that in 10 instances medics bypassed four closer facilities and in one instance a patient was taken to a hospital 20 miles further away than 12 hospitals that were closer.

Paul Hinchey, the agency's medical director, told council members that the agency brings extra ambulances into service when call volumes are known to peak, and said that patients could request medics take them to a hospital that's farther away than another for numerous reasons.

"Established provider relationships, perceived benefit, recent admission, prior experiences, availability of specialty care, or financial considerations unknown to EMS caregivers, are only a few examples of factors affecting patient choices," Hinchey said in a letter to the city's audit and finance committee in response to the audit.

Mayor Pro Tem Sheryl Cole said she understood the agency's attention to patient care but called for a balance between allowing patients to choose what hospital to go to and cost considerations.

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