Working at your home to keep you home
In May of 2013, Delta Ambulance launched a Community Paramedicine pilot program. Our goal is to serve those patients at home who would benefit from visits from a home health or social service agency but for varying reasons are not eligible to receive service from those agencies. We expect that many of the patients we will encounter during our visits will have co-existing health issues. It is our intent to utilize both ALS (advanced life support) and BLS (basic life support) providers in visiting patients in their homes. Through a decision tree, developed by our Medical Direction staff, Director of Education and Quality Improvement Manager, our Dispatchers will determine which level of service is needed based upon information provided by staff at Belgrade Regional Health Center. For example if we are simply performing a general wellness/home safety check it would be appropriate to send a BLS crew. In contrast a visit to review medications would require a Paramedic.
General Project Description
We will be providing Community Paramedicine (CP) services in collaboration with Belgrade Regional Health Center (BRHC) and MaineGeneral Medical Center (MGMC). BRHC serves a patient population of approximately 3,000 residing in the following Maine communities:
- Mount Vernon
- New Sharon
We utilize staff from our Waterville and Augusta bases, to provide episodic home visits. The request for service will be assigned to an on-duty ambulance crew based upon availability of resources we will visit the patient within 24 hours of the request, within the context of the pilot project these request are not to be of a demand response nature. A “demand response” request would more appropriately fall under traditional E-911 response or possibly a direct admit to the hospital.
Our goals include reducing the number of emergency room visits, hospital admissions, and direct encounters by BRHC staff as well as improving the overall patient satisfaction with the health care services of BRHC. To achieve these goals we will focus our initial outreach efforts on the following patient populations:
- Patients at home after recent medical hospital discharge (in which home healthcare services have not been initiated or have ended)
- Patients at home after recent surgical intervention in which significant recovery time is expected (in which home healthcare services have not been initiated or have ended)
- Patients with multiple medical comorbidities which increase their risk of emergency room use or hospitalization (ie, heart failure, uncontrolled diabetes, severe COPD) who would benefit from episodic assessments of weight, blood pressure, heart rate, oximetry and who may benefit from assistance in self-management.
- Patients about whom concerns exist for safety in the home who may benefit from a home safety/medication assessment (ie., older patients at fall risk, older patients on multiple medications)
If it so happens that when the CP arrives on scene for a home visit and the patient is in extremis, then the CP would treat the patient as set forth under current MEMS protocol and transport to the ED. As soon as possible a call will be placed to the patient’s primary care physician at BRHC to explain what the CP observed that necessitated the transport.
We have developed six Community Paramedicine Protocols specific to the four categories of patients whom we will visit over the course of this pilot project.
Medical Direction/Quality Improvement Plan
Delta Ambulance utilizes a systematic and team oriented approach for measuring performance, clinical standards, and patient outcomes. The Clinical Standards and Practice Team (CSPT) is comprised of the following:
- Clinical Quality Manager
- Service Medical Director (Physician)
- Education Coordinator
- A minimum of one individual from each of our operation locations – Waterville base, Augusta base.
- A minimum of one individual from each license level. EMT, AEMT, Paramedic, Critical Care Paramedic.
With the implementation of the Community Paramedic Program the CSPT expanded to include the Community Paramedic Medical Director (Physician).
In its regular role the CSPT measures important aspects of patient care and services through concurrent or retrospective reviews, identifying areas of:
- High Volume- 12 lead usage
- Low frequency and/or high risk procedures and/or equipment utilization
- Standards of Care identified by the Paramedic or EMS Medical Director
- Sentinel events or “near misses” that occur in the delivery of clinical care.
The CSPT analyzes any performance deficits and identifies the root cause (RCA) that contributed- be it system or individual. The CSPT then generates an action plan for improvement that includes:
- System improvement – equipment, supplies, staffing etc.
- Knowledge – education, CMEs, case reviews.
- Individual skills – informal or formal counseling with the medical director, disciplinary actions.