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Issued: August 2005

SUMMARY

This report presents the results of our audit of the Austin/Travis County Emergency Medical Services Department (EMS), approved by the City Council Audit and Finance Committee as part of the City Auditor’s 2004 service plan. Our objectives were twofold: to compare EMS service delivery with other cities for selected performance indicators; and, to examine how the department has analyzed, planned, and implemented changes to improve paramedic shift scheduling and service delivery. We referred a potential regulatory matter that was out of our scope to City management.

EMS’ reliance upon long shifts and large amounts of overtime to recruit and retain paramedics is complicating efforts to move toward shorter alternative shift options and limiting its ability to control overtime. Paramedics are scheduled to work 24-hour shifts for a total of 2,912 hours annually, which includes 832 hours of overtime (38 percent of their scheduled pay). In addition, paramedics have the opportunity to earn more pay through unscheduled overtime. As a result, the individual levels of overtime pay are routinely well above the percentage and amount that would typically cause concern in an organization. In our December 2004 audit report on citywide overtime, high levels of overtime use were connected with increased risk of safety problems and potentials for abuse, along with the problem of creating employee reliance upon the earnings. In addition, long work hours have the potential to create stress and health issues, cause absences and turnover, and add to unscheduled overtime. EMS’ use of 24-hour shifts has helped push the department’s FY 2005 budgeted overtime to $5.3 million or 25 percent of the City’s total budgeted overtime and exceeds overtime levels in all other departments, including Police, Fire, and the electric and water utilities.

For the only commonly available patient outcome measure, the department has reported a percentage that is “in the ballpark” with a national average for EMS providers. We did note that performance measures are not well developed for the industry as a whole, and may not provide an adequate basis for gauging service delivery. However, EMS’ plan to begin funding shorter shifts in FY2005 lags behind practice in other cities where emergency medical service provision is not part of a fire department. The City’s service model of providing emergency medical care independent of the fire department but using traditional fire department shift schedules is not a common one. While the Austin Fire Department has certain advantages as a civil service entity in terms of paying overtime, EMS is not covered under such an agreement. As the result of a lawsuit settlement in 2004, Austin must pay for each hour of overtime worked. The department is challenged by the difficulties of retaining paramedics and ensuring work safety in an employment climate where certified paramedics are in nationwide short supply and experienced paramedics are migrating to other healthcare professions. Other shift scenarios that can be explored may reduce scheduled overtime costs, but they entail other transition costs for recruiting and hiring more paramedics.

EMS received $340,000 in the Fiscal Year 2005 Approved Budget to begin exploring shorter shifts, but did not carry out a comprehensive cost analysis to demonstrate that intended alternative shift conversions would maintain service, offset other costs and achieve relief for paramedics. Also, they did not use accepted project management techniques that outlined scheduling, task assignments, incremental milestones and responsible parties to plan for shift conversions. Finally, although the department has the benefit of advanced technologies and is adding more capabilities, it lacks staff dedicated to analyzing data and communicating results. In recognition of these challenges, EMS has begun a consultant acquisition process but had not completed it as of the close our audit work.

Download the entire text of our Public Safety Service Delivery: Emergency Medical Services audit report (Size: 697 KB) in Adobe Acrobat. You will need Adobe's Acrobat Reader to view these files. Or request a hard copy of this audit report, No. AU04106, by submitting this audit report request form.

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