Presentation Title
David Glendenning
Education Coordinator
New Hanover Regional Medical Center
Emergency Medical Services
Our EMS Reality In 2013
• 9-1-1 has become the safety net for non-emergent healthcare.
• 29% of 9-1-1 requests are non-emergency
• Top 10 users of our 9-1-1 system accounted for 702 EMS responses
• ED turn-around-times increasing
The questions:
• Are we providing the right level of services?
Early CP Success CHF Beta Patient
• 56 y/o male CHF patient • Admitted to NHRMC five
consecutive times weekly for an average cost of $14,000.00 per week • 911 use on every instance
• Referred to us by case management • We agreed to partner with Hospice
First Time Visit by “CP” discoveries
• Pt didn’t understand how to inject IM Lasix
• Lasix doses were crystalized in refrigerator
• Medications were duplicated
• Lighting in bathroom was broken • Several high sugar/high salt foods
in kitchen
• Bi-pap unit was not being utilized and worn backwards when
attempted
• Anxiety PRN meds not being
utilized properly around the same time he tended to call 911
Results Post CP visits
• Lighting was fixed via building staff • New Bi-pap mask and fitting
• Medications reconciled
• Pt utilized PRN Ativan as needed • Support from family and friends
increased
• Working relationship with Hospice Rn’s
• Depression decreased
• Pt began to take short trips from his apartment
• Diet improved
• Was able to administer IM Lasix and handle his crisis twice at home
•
Over 7 months, he was
admitted twice for anemia
•
Made all of his scheduled
medical appointments
•
QUALITY OF LIFE
IMPROVED
CHF Beta Patient Results
0 5 10 15 20 25 Pre PostEMS TRANSPORTS PRE & POST COMMUNITY PARAMEDICINE
PROGRAM
Financial Impact on the Hospital
$339,199 $118,454 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000Annualized Hospital Charges Pre & Post Community
Paramedicine
Program Description
•
Reduce unnecessary 9-1-1 utilization and ED visits for our familiar
faces/familiar places.
- Proactively manage care and serve as a trained navigator of
community resources
•
Improve NHRMC’s readmission rates.
- Care for high risk patients within 50 miles of our hospital
•
Partner in healthcare system integration & care coordination.
- Work in cooperation with other stakeholders/medical providers
•
2.5 FTE’s carry out the program’s operations.
- Home visits consist of clinical and home safety assessments, medication
reviews, and in some cases, treatment of acute medical needs
Filling A Gap In The Plan Of Care
•
Paramedics already have a good
understanding of the CHF patient
in crisis
•
Under existing scope of practice,
they can administer many
medications needed
•
With enhanced training, they learn
more about the disease process
including:
medication reconciliation
proper diet and nutrition
weight management
NHREMS-CP Provider Education
Total: 308 hours of didactic and clinical education
• 64 hours classroom (via web classroom with other state programs) • 48 hours online modules
• 196+ hours clinical education
– Hospice rotation (inpatient, home visits, social work, clergy, etc…) – Cardiovascular rotation ( inpatient, office, procedures, etc…..) – Behavioral rotation ( CIT training, inpatient, home visits, etc…) – Internal rotation ( inpatient, team focus, detailed H&P, etc…) – Pharmacy rotation ( medication reconciliation)
– IV access lab ( specialized access including central lines, ports, etc…) – Nutrition
– Free clinic (serving internal needs for indigent population) – Case management, social service, etc…..
NHRMC CHF Re-Admission Reduction Strategies
• Re-Admission risk assessment • Roadmap to discharge
• IP Case management visit • Pharmacy bundle
• Schedule follow-up appointment • Transition calls
How Do We Follow This CHF Patient After Discharge?
•
Do our patients truly understand
discharge instructions?
•
Do they have the support at home?
•
Will prescriptions be filled?
•
Will they make it to scheduled
appointments?
6 Month CP CHF Readmission Data
•
77 patients
•
9.3% readmission rate at pilot close (national average 22.6%)
•
Quality of life increased
•
Creation of bed availability; 30-day readmission penalty avoidance; cost
avoidance for low/no payors
CP Results: First Medicaid Patients
16 $235,677 $55,179 $63,303 13 6 8 29 2 4 0 5 10 15 20 25 30 35 $50,000 $100,000 $150,000 $200,000 $250,000Pre In Program Post
Community Paramedicine ED Familiar Faces Patients
Patients with Medicaid Primary & Medicaid Secondary Annualized
Charges Inpatient Visits ED Visits
Proven Success = More Grant Funding
•
$900,000.00 in additional grant
funding
•
Reports from the Community
Paramedic grant #1 verified
success
•
Comprehensive readmission
avoidance package
•
Included creation of Pharm-D,
2 Case Managers, resources,
New Hanover Regional EMS CP Program’s Future
•
Continue the “hospital based” focus
for the improved health of the
populations
•
Continue to build partnerships with
other services in the community
•
Population Health Management
through data driven education
•
All Cause Readmissions
o Stroke (900 admissions a year) o Pneumonia
o Chronic Obstructive Pulmonary Disease
o Post surgical discharges (CABG)
