Integrated central control center in Lahn-Dill County

Lahn-Dill County

Size: 1060 km²
Population: 260 000

Address

Franz-Schubert-Straße 4

35578 Wetzlar

Description

Coordination, cooperation and communication for emergency medical services, on-call medical units, fire department, disaster control, disaster operations, etc.

• Fire / Accident / Emergency: 112
• On-call medical units (A.N.R.): 06441 19292
• Emergency medical services / patient transport: 06441 19222
• Emergency fax for deaf and hearing impaired: 112

Personnel manning the control center

• Two to three skilled and trained dispatchers 24 hours / day

• A professionally experienced doctor specifically trained for the work at the control center in the area of medical emergencies outside of working hours (from 7pm to 7am on weekdays; Wednesdays starting at 2pm; from Fridays at 7pm through Mondays 7 am nonstop ).

Development of medical emergency calls in the region

Founding of the club "Medical emergency calls in the region" in 1996

• Unanimous declaration of intentions from the county of KVH as well as the county government of Lahn-Dill County to work together on emergency services in the future with the central control center (CCC).
• Negotiations with the KVH and health insurance companies.
• 1999 contract conclusion (exemplary contract based on §63 of the SGB-V) after the Hessian ministry of social affairs mediated between the KVH and insurance companies.
  Costs assumed by the insurance companies, joint financing of the evaluation.
  Counter-financing through savings in prescriptions as well as through counter-financing through savings in emergency services and hospitalization.
• Since the 4th quarter in 1999 (almost 10 years), doctors have been in the CCC.

Description of the integrated control center in Lahn Dill

• Through the emergency number 112, emergency medical services 0644119222, or on-duty medical units 0644119292, the citizens of Lahn-Dill County can reach the team at the control center 24 hours / day.

• All telephone calls go into the same room of the control center and are redirected according to the type of emergency.

• The doctor and dispatchers are connected to the IT server from all work stations and have personal contact in an open-plan office.

• Consistent structures and courses of action lead to high levels of dependability and thus to a higher level of care.

• All telephone numbers of general practitioners and specialists, clinics and other medical care centers, as well as the duty hours of practicing doctors are available and up-to-date.

• The patient seeking help has access to a constant, comprehensive, and professionally qualified consultation by the doctor at the control center at all times.

• Critical situations are sorted out immediately.

• Reactions to medical emergencies can occur with no loss of time.

Advantages of the A.N.R. in the central control center

• Around one third of the medical requests during the doctors' on-duty time can be conclusively answered by the doctors' telephone consultations.
• Patients' hospitalizing themselves in clinics hardly happens anymore.
• House visits and visits to the on-call practices have been drastically reduced.
• There has been a reduction in MICU and emergency on-call visits and thus a reduction of hospitalization.
• Improvement of the degree to which the maximum responding time has been met in Lahn-Dill County because emergency vehicles are available more often. The provision of two more vehicles is no longer applicable.
• The number of emergency services communities was lowered. More reductions are being planned in the areas of Lahn-Dill County.
• Just in the year 2007, more than 2000 unnecessary deployments of the emergency services – which were requested through the emergency number 112 – were avoided. In these cases, the dispatcher is legally required to send at least one emergency vehicle. Only the cooperation with an accountable doctor makes another decision possible.

• Lahn-Dill County has organized the emergency medical personnel for the on-call doctor system for many years.
• Around 100 qualified emergency doctors from the clinics and private practices are available in the Lahn-Dill County. The cooperation and communication of the ANR with the emergency doctors has resulted in the ability, e.g., to mobilize a large number of doctors in a short time for serious emergencies involving many injured or in disasters.
• The operation control center for the county's executive staff as well as for the disaster protection unit is the control center, i.e. within the same building. In this way it was integrated into the control center and connected to the IT system used by the doctor at the control center.
• Volunteers in the center are also integrated and can be called on in crisis or if back-up is needed.

Through the founding of the A.N.R. and its integration into the control center, over 130 doctors' practices, including more than 240 doctors, and five local hospitals are connected to one communication network. 

The mutual acceptance and recognition has greatly risen. At all levels, there have been discussions without reservation or self-interest, projects have been initiated, and problem-solving has been aimed for.

Inter-sectoral quality meetings take place on a regular basis.

Coordination of palliative care and support of homeless in cooperation with Caritas can be done much more easily.

Economic aspect

In comparison to other regions, Lahn-Dill County was able to save more than 2,000,000 Euros each year net for the health insurance companies.

Numbers

Total cost of the project, approximately 650,000 Euros       
Aqua Institute, Report timeframe 2004q1 until 2007q1:

Success appraisal in the area of pharmacotherapyThe savings calculations show that, for the entire time frame observed, the yearly goal of 350,000 Euros saved will once again be greatly exceeded. The total savings – achieved by the A.N.R. project – for the quarters 2005q1 until 2007q1 reached 3,320,270 € in favor of the health insurance companies.

Success appraisal in the area of emergency medical services

Due to the A.N.R. project, no further emergency medical stations needed to be set up in Lahn-Dill County, and no additional multi-purpose vehicles had to be procured.
It can be said that the legal requirements for responding time in Lahn-Dill County have been met 100%. Without the program, more emergency medical stations would have had to have been set up and/or new multi-purpose vehicles would have had to have been procured.

Self-evaluation:

a.    Savings in the area of pharmacotherapy:

It was proven (evaluated) that more than 13 Million Euros were saved in Lahn-Dill County between 2000 and the end of 2007 to the benefit of the insurance companies. (Basis for calculation: Savings 2005q1 to 2007q1) Sum saved per year: approx. 1.6 Million Euros  

• The insurance companies will in the future no longer take the savings in the pharmacotherapy area into consideration in their success appraisal of the A.N.R. This was decided by consensus by the project advisory board.

b.    Savings in the area of emergency medical services:

• The following information is based on reports from the county inspector, Rupert Heege, Lahn-Dill County.

In 2007, around 2300 calls to the 112 number could be transferred into medical on-call services, so called “A.N.R. operations”. This reduced the number of emergency medical deployments (with house visits or ambulances) by around 2300. The result of the year 2007 can be extrapolated for the years 2000-2008. Without these “transfers,” two additional emergency vehicles would have had to have been procured in 2000 and then maintained in order to ensure the maximum responding time was met. Annual maintenance costs for two vehicles are currently approximately 850,000 Euros.   

• Return trips from the hospital back home are not included here.

c.    Savings in the area of inpatient treatment:

Emergency service responses before the introduction of a doctor at the CCC generally led to transportation of the patients to the hospital because of a lack of communication structures between emergency service personnel and the on-call services. There the patients had to be admitted (at least briefly) as inpatients for the same (and some other) reasons. 

• Because of a lack of information from the insurance companies, the savings in this area can only be estimated. In the calculation, only the incurred minimal costs are assumed.        

Based on the minimum cost of a “hospital emergency” (150 Euros per case), the savings in the area of inpatient treatment were at least (150 Euros x 2300 cases)  345,000 Euros.   

           

1a. Sum of costs / savings with pharmacotherapy (in Million Euros):

Savings pharmacotherapy	~	approx.	1,66
Savings emergency services	~	approx.	0,85
Savings inpatient	~	approx.	0,35
	__________________________
Total savings			2,86 Million Euros
Costs	~		0,65 Million Euros
	__________________________
Net savings	~		2,21 Million Euros

 
 
 
         

1b. Sum of costs / savings without pharmacotherapy (in Million Euros):

Savings emergency services	~	approx.	0,85
Savings inpatient	~	approx.	0,35
	__________________________
Total savings			1,2
Costs	~		0,65
	__________________________
Net savings	~		550,000 Euros

 
 

1. It should be noted that the the savings in the area of inpatient treatment were estimated at the lowest level possible.

2. The procurement costs for emergency vehicles are not included.

1st Note

Qualitative improvement of patient care

• significant improvement in the quality of emergency patient care
• a standardized emergency number good for everyone
• all emergency numbers are directed to the large office at the control center and are dealt with in cooperation with a practicing doctor
• an increase in the satisfaction of the affected citizens – measurable on the very small number of complaints in comparison to other regions
• increase in the satisfaction of all of the “helpers” in the emergency services

2nd Note

Qualitative improvement of the system

• The functionality of the system requires a cooperation of the integrated sectors on equal terms.
• The system can be transfered with no problems to all rural-structured regions in Germany. Requirement: the existence of a CCC.
• The savings potential – here only calculated for the emergency service area for Lahn-Dill County – is exponential.

3rd Note

Inclusion of additional care areas through A.N.R. and control centers

• The implementation of palliative care on the basis of the paragaphs 37b and 132c SGB-V would be much easier and cost-efficient with the help of this form of organization. 
• The implementation of a pandemic plan is essentially secured with the help of this organization form, as the reliable access to practicing doctors is guaranteed at all times.
• The disaster planing would also be faster and better to organizing according to point 2. Drills would be easy to organize and carry out.
• The development of projects – positive lists, guidelines, cooperation with pharmacies, hospitals, health insurance companies, etc – are easier to organize.

4th Note

• The described cooperation system is essentially something new, the implementation of which is not included in the mandate of a emergency service entity.
• The cooperation is made possible through a contract between the Association of Statutory Health Insurance Physicians in Hesse (KVH) and the state health insurance companies.
• The health insurance companies assume the costs – but they also take advantage of the savings and qualitative improvement of the care for their insured.
• The existing contract had to be renewed annually up to this point.
• Despite evaluation and annual evidence, the insurance companies have until now not noticed the extensive advantages of this organization (qualitative improvement and simultaneous sinking costs), let alone recognized and/or publicized.
• The KVH has seen the advantages and greatly supports the “medical emergency call center” in Lahn-Dill County.
• The politicians have seen the advantages of this system but leaves all contract agreements largely to the joint self-administration.

Future Prospects

• The cooperation between statutory health insurance physicians and the central control center that has been tried and tested in Lahn-Dill County for years is an ideal implementation of the letter of intent on the introduction of interface management between emergency services and on-call doctors in Hesse.
• Interfaces without the inclusion of a doctor's expert opinion and accountability inevitably lead to rises in cost for the system.
• Interfaces without the inclusion of a doctor's expert opinion and accountability usually lead to a loss of quality in patient care.
• At least the ANR club's idea to create cooperation in the form of the „medical emergency call center“ in the CCC of Lahn-Dill County should be safeguarded and continued by means of a contract for several years. 
• The system in point 4 should continue to be financed by the insurance companies. It must – and can (see savings) – receive more financing so that honorariums can be brought up-to-date and further structural measures in the region can be started.
• The system could be recommended and publicized as a joint project of the KVH, insurance companies, and communities for other regions.

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