Gold Cross Ambulance
Salt Lake City, Utah
Gold Cross Ambulance was founded in 1968 with the vision of providing quality medical care and customer service to anyone regardless of race, creed, color, religion. or the ability to pay.
Gold Cross Ambulance employs highly trained and certified paramedics, EMTs, and other medical professionals. With a fleet of specially-equipped emergency vehicles and a state-of-the-art communications center, Gold Cross responds to calls in Salt Lake, St George, Uintah, Utah, Washington Iron, and Juab Counties.
Gold Cross Ambulance exceeds all established standards for emergency response protocols and is fully integrated with other local, county, state, and national emergency response agencies to assure a seamless benefit to the community. The company is certified by the Commission on Accreditation of Ambulance Services (CAAS) and is the first ambulance provider in Utah to achieve this national distinction. Gold Cross is the 112th Center for Excellence with ACE Accreditation from the International Academies of Emergency Dispatch IAED.
In 2020, Gold Cross Ambulance in Salt Lake City, Utah met the challenges of COVID-19 by closing their buildings to non-employees and assessing the impact on EMTs and Paramedics. Extensive measures were implemented to protect employees, patients, and the communities they serve. As management learned more about the virus, they adapted and refined best practices.
Gold Cross established protocols to determine if a patient was exhibiting signs of COVID-19 so EMS crews could don PPE. Ambulances were routinely taken out of service and crews performed a stringent two-hour decontamination process.
In addition to COVID-19 cases, Gold Cross teams were shaken by a 5.7 magnitude earthquake on March 18, but continued working. September 8, Salt Lake experienced hurricane-force winds that uprooted hundreds of trees, and Gold Cross crews were ready to assist. October 7, Salt Lake welcome the Vice Presidential Debate and Gold Cross worked closely with the Secret Service to assure the safety of the candidates.
2020 tested the company’s capability to respond to unprecedented events. Gold Cross has affirmed that they can withstand any crisis and are ready to react quickly and effectively.
40 Under 40 nominees were selected based on their contributions to the American Ambulance Association, their employer, state ambulance association, other professional associations, and/or the EMS profession.
Gold Cross Ambulance Service, Inc.
Nick is currently the Systems Director for Gold Cross Ambulance Service, Inc. Nick has 10 years of EMS experience and has proven to be a solutions-oriented systems thinker. Nick is genuine, thoughtful and puts employees at the top of his priority list. Nick is a young, promising leader in EMS.
Reason for Nomination:
Nick has worked his way up from Paramedic to Systems Director in just six years. Even as a new Paramedic in the Gold Cross system, Nick was eager to get involved, create efficiencies, and solve problems. Nick was quick to volunteer for projects, build community partner relationships, and navigate a path for progress. Nick has been recognized as a Wisconsin Star of Life nominee and was recently awarded a Future 15 award. Nick currently serves on the PAAW Board and was recently elected Vice President of that association.
When Gene Moffitt founded Gold Cross Ambulance in March 1968, he didn’t know that 50 years later the company would be where it is today, the longest-running and largest private ambulance service in Utah.
At its core, Gold Cross is a family-run business. In fact, Gold Cross started out of the Moffitts’ home after he rented two Cadillac ambulances. In the beginning, Moffitt and two or three other employees responded to calls from the family home, where his wife, Julia, oversaw dispatch operations while caring for their young children. Julia has been central to the business since the beginning and has played an essential role in Gold Cross’s continued success.
Today Gold Cross employs over 500 people, operates around 140 ambulances, and responds to hundreds of 911 calls a day. Despite this growth, Gold Cross remains a family business with deep roots in the community—something that the Moffitts are very proud of.
Moffitt points to a couple of factors that have made Gold Cross’s journey a successful one. First, he’s always had a knack for being in the right places at the right time. But he believes that being honorable to the commitment he has made to provide high-quality healthcare to the people of Utah has been critical to his company’s ongoing success. “Success has not come to Gold Cross without much sacrifice over the years,” Moffitt says. “Growing and expanding has not been an easy process, but with dedication and a bit of luck, Gold Cross has been able to overcome the many trials and tribulations we’ve faced.”
Of course when you’ve been in business for 50 years, you’ll have seen many changes to your industry. Moffitt says one of the biggest changes he’s witnessed has been the buyouts of many ambulance services over the years, and that’s something he believes has been both good and bad for the industry. “When large companies buy out smaller ones,” he explains, “the connection of the ambulance service to the community that there was in the past is lost.” Moffitt notes that Gold Cross has never tried to go into another area unless it has been asked to. “Going into a new area to provide service is a delicate process,” he says. ”You must re-prove yourself to the community while being sensitive to the locals and to employees who may come over from the previous provider.” As a family-run business, nurturing the bond between Gold Cross and the communities it serves has always been very important to the Moffitt family.
Looking back on a more personal level, Moffitt has many memories he is proud of. The other day he came across a photo of one of the first babies that Gold Cross transported by ambulance in 1968 or 1969. Gold Cross worked closely with Dr. Larry Jung, a pioneering neonatologist, to help him provide life-saving care to children in Utah. “I’m in awe of how the medical community has really evolved over the last 50 years to give sick newborns and infants a better chance to live,” Moffitt says, smiling. “The baby in that photo would now be 50 years old!”
Gold Cross was also involved in the first heart transplant that took place in Utah. Gold Cross helped the hospital move the patient back and forth with the tremendous amount of equipment necessary for the procedure. The company also played a large role in the Salt Lake City Olympics back in 2002.
Moffitt also made many lifelong friendships because of his involvement with the AAA, including through his work as a past President of the association. He notes that the early AAA days were very important to his work at Gold Cross, giving his ambulance service access to resources and information that Gold Cross would not have had on its own. “The AAA helps foster a friendly relationship amongst providers,” he adds, “and members are very willing to share information about best practices and other experiences.”
Moffitt is working on bringing the company’s past and present together very visually, while giving a confident nod to the future. Gold Cross is refurbishing its remaining 1960 Cadillac ambulances and has also purchased a new ambulance to celebrate the 50th anniversary. When the brand-new ambulance is shown off alongside the 1960s ambulance, it will give a clear picture of where Gold Cross has come from and where the company is going.
And of course there will be numerous celebrations with staff and family, both of whom have been critical to Gold Cross’s success over the years.
One thing that has stayed exactly the same? Moffitt’s vision for Gold Cross—“to provide quality medical care and customer service to anyone, regardless of race, creed, color, religion, or the ability to pay.”
Please join the AAA in congratulating Gene, Julia, the Moffitt family, and Gold Cross Ambulance on 50 years of providing high-quality healthcare to the people of Utah.
Congratulations, and here’s to many more successful years!
The documentation review process at Gold Cross Ambulance had not changed much since the day of paper trip tickets. Retrospective documentation feedback was being given to crews, but they were not fully utilizing the capabilities of their technology to analyze the feedback and make significant improvements. Gold Cross Ambulance hypothesized that improved documentation goals would lead to better patient care and increased reimbursements. They knew they needed to make improvements in the review process and to better utilize the technology that was already in place. In addition to the documentation goals, they identified the opportunity to work some small, but significant, clinical improvements into a documentation project. One initial focus of clinical improvement was making sure the field crews were obtaining at least two sets of vital signs on every patient, and properly documenting these vital signs in the electronic patient care report (ePCR). Of all the performance indicators we measure, trending of vital signs touches every patient contacted. Educators from Utah EMS for Children shared research citing “inadequate recognition of and response to hypotension and hypoxia was associated with higher odds of disability and death” (Hewes H., 2016). This was such a basic thing to measure, but it had potential to impact every contacted patient. Gold Cross know that vital signs were an area in which they could improve, while also meeting their documentation goals. To do so, they implemented the following:
Create a way to measure overall documentation quality.
Establish a formal standard for documentation and educate crews about the documentation expectations.
Improve the overall documentation of the ePCR.
Improve the number of patients with properly collected and documented vital signs.
Improve amount of reimbursement and decrease collection cycle time.
Gold Cross formed a work group to tackle these issues, which consisted of members of the Quality Department, Training Department, Billing Department, and Operations Department. The group meets every other week to evaluate progress and assess the need for adjustments to the system. Mid-year of 2014, the group worked to revise the program for documentation evaluation. A new standard was created based on the ePCR fields. A point system was established for documentation which gave each ePCR field a weighted number of points, equaling 100%. Incomplete or missing fields result in a loss of points for that field, which provided a way to measure documentation performance. The scoring data is tracked in our ePCR quality module, allowing us to analyze and report on the data easily. The feedback on any areas of missed points is sent to the crew via the ePCR messaging system, so it is easily accessible to the crews during regular daily tasks. Feedback is focused on improvement comments instead of punitive comments. Positive feedback is included in each evaluation. The group released an initial version of the General Instructions for the ePCR, which was an internal manual detailing expectations for every field in our ePCR. The focus was to provide clear expectations to all field crews regarding how to properly fill out the ePCR and what content should be included. The training department created an educational program on the online educational software program, detailing the documentation guidelines and testing the crews on the material. The General Instructions for the ePCR were also posted on the company training site, so crews would have easy access at any time. The Quality Department developed a class for the newly hired providers. The class emphasizes the need for quality documentation, outlines the program, and includes actual documentation examples for evaluation and discussion. Patient advocacy through documentation is instilled in the participants of this class. The Billing Department developed a class which is taught at six months after hire. In the class, documentation is reviewed from class participants. The billing department shows how the bill is processed from the documentation, and they discuss common challenges to the billing process. The program has been monitored with continuous PDSA cycles and has been adjusted as needed for continued improvement.
An initial company goal for documentation was set at 90%. From project start to current date, the company-wide documentation averages have increase from 74% at the beginning of the project to 96% currently. Field crews have expressed greater clarity in the company expectations for documentation. The overall average documentation scores by division are posted regularly for the company to view, and this has had the additional benefit of sparking a competitive streak between some of our divisions, further improving the scores. The improvement in collection of vital signs not only improved overall patient care, but resulted in a Performance Improvement Award from the Utah State Bureau of EMS in 2016. The bureau looked at pediatric vital signs and recognized two rural and two urban EMS agencies in the state for their improvements. Gold Cross Eastern Division won the award for a rural agency, and Gold Cross Salt Lake Division won for the urban agency. Their study found our agency improved the collection of pediatric vital signs by 53% in our urban area and 66% in our rural area.
The most important impact of this project is improvement in patient care, which is our primary mission. The goals for complete documentation have encouraged field crews to make sure they complete proper assessments, since they know those areas of the ePCR are evaluated and must be complete. Improvements in assessment result in better differential diagnoses and improved treatment plans and outcomes. The documentation project has positively impacted Gold Cross financially as expected. Reimbursement rates have increased and the time to complete the collection cycle has improved. Due to the documentation improvements, the billing staff spends less time researching information, following up on incomplete documentation, and fighting in appeals.
Congratulations to Gold Cross Ambulance for the Reduced Readmissions Project’s selection as a 2016 AMBY Winner for Best Community Impact Program.