Building Toward Better Care

Upgrading equipment and service in a rural area

 

 
 
 

Cynthia Kincaid | From the EMS 10: Innovators of EMS 2013 Issue


Humboldt General Hospital prides itself on providing its 8,000 local and 17,000 county residents with the best possible care. It seems like an achievable goal but, in fact, it’s an aspiration that has been hard fought and hard won.

The journey the Winnemucca, Nevada-based hospital has taken from its modest 1897 roots of just six rooms to a present structure that includes a new 35,860-square-foot expansion, complete with a $10 million computer system integrating all hospital technologies under one network, has been more than a century in the making. But, arguably, it’s the vision of Humboldt’s CEO, Jim Parrish, MBA, FACHE, FACMPE, that has been the driving force in making profound changes to the hospital by bringing it and its EMS and medical staff into the 21st century.

System Upgrade
Parrish arrived at the hospital in 2004 to find Humboldt’s EMS department made up largely of volunteer EMTs. He also found the hospital staff working with insufficient and antiquated equipment and, on top of that, there was a shortage of critical personnel. All of these issues posed particular challenges because the hospital’s EMS department was responding to more than 1,200 calls a year. “I knew we needed to upgrade our equipment and ambulance service right away,” Parrish says.

And upgrade he did. The hospital now has a primary and secondary rescue truck, the oldest having been around for just four years. Recently the hospital purchased a combination ambulance and rescue truck—a $400,000 investment. Parrish then began upgrading the hospital’s equipment and technology to state-of-the-art systems and devices.

Trickiest of all, Parrish moved the hospital away from a volunteer-based system to hiring full-time paid EMS personnel. “People take a lot of pride in volunteering, but in order to improve our patient outcomes and response times we had to go with a paid service,” he says. EMS is now staffed 24 hours a day. Volunteer EMS is still part of the hospital’s personnel structure, but they serve on a casual call basis. “They come in and backfill,” Parrish says. “So we are still able to respond within five minutes, if we get stacked up with four calls.” And a paramedic now rides on every rig.

Parrish also addressed the need for paramedic training. Prior to his arrival, paramedics had to go elsewhere to receive the medical training needed to be part of the hospital’s EMS team, so Parrish arranged for people who had been trained at other facilities to work with Humboldt. In the simplest terms, he hired them to be a part of the hospital. He also drew up an agreement to partner with a local college to teach accredited courses to Humboldt’s paramedics. “We just graduated almost a dozen individuals,” Parrish says. “Nine of them have taken and passed the exam.”

Not only have these changes significantly impacted the Winnemucca community, but Parrish also has helped save the county millions of dollars. Before he arrived, patients were routinely flown more than 170 miles away to Reno’s tertiary care facilities. “A flight service crew flew them, which cost $30,000 a flight,” Parrish says. Now patients are transported by ambulance at a cost of $8,000 per transport. “On average, we save our community about $4 million a year,” he says.

Developing Partnerships
All of this effort has not only changed the perception of Humboldt General Hospital, but of paramedics as well. “Our paramedics are viewed as heroes because they are the ones who show up at four in the morning,” Parrish says. “They are all well received.”

Parrish has also partnered with the local police department and created the first-ever police-paramedic program. It all started when one of the hospital’s paramedics left to work for the Winnemucca Police Department, and Parrish saw an opportunity. “We talked to him and said it would be cool if he could play a dual role of police officer and paramedic,” says Parrish. He agreed with that idea, and so did the chief of police. “We bought the jump bag for his car, which is marked as a paramedic car. He is the first call, so we are able to get someone on scene within two or three minutes,” he says. “Sometimes he can go on a call and clear it, so we don’t have to roll out an ambulance with two paramedics. He’s already saved two lives.”

Parrish is so pleased with the outcome that another officer, this time with the Winnemucca Sheriff’s Office, will be taking on the same role. “He has just completed his classes, but he hasn’t taken his test yet,” Parrish says. “Once he takes his test and passes, he will be a paramedic on the sheriff’s side.”

None of this would have been possible, says Parrish, without the full support and enthusiasm of the chief of police and the sheriff’s office. “Both the sheriff and the chief of police are very forward-thinking and concerned about community safety,” says Parrish. “They see this as a huge step forward in keeping the community safe, and they’ve embraced it.” They’ve also, no doubt, embraced the cost savings. The response vehicles for the two law enforcement paramedics have cost between $2,000 and $5,000—a tab the hospital has picked up. “It’s nice for them because the police force has a limited budget,” Parrish says.

Community Health
Parrish continued to seek additional opportunities to impact the community, and he spearheaded a community paramedicine program. Rather than just sending paramedics on emergency calls, Parrish and the hospital are trying to improve the health of the community by having paramedics make welfare checks on residents.

“This is a physician-supervised program for people with chronic diseases, such as chronic obstructive pulmonary disease (COPD), congestive heart failure or diabetes,” says Parrish. “A paramedic might visit once or twice a week. They make sure a patient is taking their insulin or following their diet plan. More than just dictating to people, they are trying to connect with these folks and teach them how to take care of themselves.”

To illustrate how effective the program has been, Parrish recalls a COPD patient who ran up a hospital bill of $212,000 over a two-year period. Last year, that same patient was enrolled in the paramedicine program. She was hospitalized only once and had a bill of only $12,000. “It’s early yet,” Parrish says, “but we’ve had tremendous success. We think if we can teach these people, monitor them, and be friends with them, we can raise their health status so they are not dependent on the emergency room and the hospital.”

Ease of Care
Every year, Nevada plays host to thousands of people in an annual gathering in the Black Rock desert known as Burning Man, and Humboldt General Hospital is the medical provider for the event. In 2010, approximately 80 people in need of medical attention had to be taken by ambulance to Reno, which was costly and time consuming. In 2013, Parrish changed that through an initiative that had the hospital provide “self-contained” medical care. Humboldt’s EMS provided medication on the premise, as well as onsite labs, ultrasound and teleradiology that could be read on a real-time basis. Last year, Humboldt transported just 28 people to Reno from the Burning Man event, out of a population in excess of 68,000.

The initiative was so successful that Humboldt purchased a portable X-ray machine to provide the same service to the Winnemucca community. “If somebody is homebound, we can take that unit to the house and do the X-ray without them having to come in,” Parrish says. “It saves the community time, effort and money, as well as giving people access to medical care.”

For Parrish, all of these innovations are simply a way to provide better healthcare to his community. He acknowledges that keeping people out of his hospital will have an impact on revenue, but he thinks medicine will evolve in the future to the point that people can receive alternative care without putting hospitals like his out of business. “It’s getting back to common sense,” he says. “We’ve lost common sense in this country when it comes to healthcare. We’ve got to get back to people understanding how to take care of themselves and not going to the ER with colds and sniffles.”

If Jim Parrish can be part of the dialogue, and part of the solution, you can bet that the changes will be far reaching for everyone involved.

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Administration and Leadership



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Related Topics: Administration and Leadership, Jim Parrish, EMS10, EMS 10 award, Cynthia Kincaid

 

Cynthia KincaidAn award-winning writer who has written numerous articles for medical and health-care publications and organizations. She was the recipient of a 2007 Excellence in Journalism award from the Society of Professional Journalists. Cynthia holds a bachelor s degree in journalism and a master s degree in public administration. She is a frequent JEMS contributor

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