Mobile Integrated Healthcare, News, Patient Care

Reno Roundtable Brings International Look at Community Paramedicine

Issue 1 and Volume 40.

The 10th Annual International Roundtable on Community Paramedicine (IRCP) was held Sept. 2–5, 2014.

Started in 2005 from modest beginnings of a meeting of 50 delegates from Australia, Canada, Scotland and the United States, this year’s conference in Reno, Nev., was attended by over 200 representatives from Australia, Canada, England, Ireland, Norway, the United Arab Emirates, and the U.S. The record attendance is a testament to the strong international interest in community paramedicine and mobile integrated healthcare. Of course, some of the allure of this year’s IRCP may have also been the scenic Reno location, or the close proximity and timing of the legendary Burning Man festival. Many of the IRCP attendees also served as medical and support staff for the 68,000 people who made Black Rock City the third largest city in Nevada for the five days before the IRCP conference.

The IRCP opening ceremony consisted of a breathtaking presentation of the colors by the Humboldt General Hospital EMS Honor Guard and a moving rendition of the Star Spangled Banner. The Regional EMS Authority (REMSA), the host agency for the event, secured several notable speakers as part of the official welcoming committee.

Nevada Assemblyman James Oscarson welcomed the attendees and presented proclamations from the governor of Nevada, Brian Sandoval. In his welcoming remarks, Oscarson was able to speak with some authority about healthcare issues because of his background as a nurse, and currently serving as a hospital administrator at Desert View Hospital. Tracey Green, MD, the chief medical officer for the Nevada Division of Public and Behavioral Health, extended her welcome and shared her excitement regarding the groundbreaking work in community health being conducted by REMSA’s team in Reno.

Insights

Over the course of the following three days, attendees were treated to numerous presentations and informational updates. With virtually all presenters making some reference to the Institute for Healthcare Improvement (IHI) Triple Aim, IRCP organizers shrewdly invited David Williams, PhD, the chief executive and consultant from the Medic Health consulting group to describe community paramedicine and mobile healthcare through the lens of the IHI. Williams is an improvement advisor with the IHI who has worked on several EMS-related improvement projects.

Among the points articulated by Williams was the focus on the patient’s experience of care, which includes not only patient satisfaction, but also the patient’s ability to access appropriate healthcare resources to benefit their overall clinical outcome.

Justin Sempsrott, MD, from Lifeguards Without Borders, gave a lighthearted insight into the complexities of providing medical services at Burning Man—clearly one of the most “interesting” mass gatherings

In 2013, 300 medical and non-medical personnel, using eight ambulances and one quick response vehicle, treated 3,011 patients. Most were walking wounded, but there were 41 critical or life-threatening emergencies transported to area medical centers.

Sempstrott explained community paramedicine was a key component of the medical services provided at Burning Man, where paramedics followed standing order protocols for antibiotics, suturing, and treatment of the ever-present UTIs, most commonly the result of prolonged exposure to hot, dry temperatures and no showers for a week.

Susan Long, the director of clinical and support services at Allina Health in Minneapolis (and current president of the North Central EMS Institute), shared Allina’s experience with implementing a hospital-based community paramedicine program.

Among Long’s messages was that being part of a large health system has its advantages and disadvantages. Competing projects and a large, very diverse workforce made it difficult to get their program off the ground.

Today, Allina’s CP program is focusing on high ED utilizers and patients at risk for 30–45-day readmissions. For the first 22 patients enrolled in the readmission program, one patient had an admission at day 36 and one at day 45. For the ED utilizers, 78% didn’t have an ED visit within 30 days of their ED discharge.

Data, Data, Data

With many of the community paramedicine programs operating for over a year, outcome data is beginning to trickle out of the
programs. Brenda Staffan of REMSA provided the preliminary data from their Healthcare Challenge Innovation Award (HCIA), citing that since December 2012, their Ambulance Transport Alternative (ATA) program avoided 550 ED visits and 55 ambulance transports.

Their post discharge follow-up program has enrolled almost 350 patients with an all-cause readmission rate of only 13%. The REMSA Nurse Advice Health Line has fielded nearly 16,000 calls with 1,149 ED visits and 190 ambulance responses avoided since implementation in October 2013

Chris Montera from Eagle County Paramedic Services (ECPS) in Eagle County, Colo., provided their program’s outcome data, revealing 350 flu vaccines have been administered, the hospitalization rate has been reduced by 76% through their Project RED initiative, and 100% of enrolled patients have an established medical home.

Montera provided more detailed actuarial data on the 91 patients who have been enrolled in their program. In this population, 313 community paramedic visits were provided and prevented 167 physician visits, 43 ambulance transports, 39 ED visits and 806 days in a skilled nursing facility. In total, the ECPS program has produced $412,000 in healthcare savings.

For the MedStar program in Fort Worth, Texas, I highlighted the outcome results of my programs. Specifically, the “EMS Loyalty” program has reduced ambulance transports to the ED by 1,657; the congestive heart failure readmission prevention program has reduced hospital readmissions by 74% and the 9-1-1 Nurse Triage program has prevented 697 ambulance transports to the ED.

MedStar is also closely tracking patient satisfaction and overall health status for the enrolled patients. For the patients surveyed who called 9-1-1 and received something other than an ambulance to the ED, 80% agreed with how their call was handled and 87% said the way it was handled saved them time and money.

Regarding self-reported health status, patients in the EMS Loyalty program reported a 29% improvement in overall health and patients enrolled in the CHF program reported a 54% improvement.

Putting it into Perspective

This was an international conference. Many presenters reminded their U.S. counterparts that places like the United Kingdom, Australia and Canada have been doing community paramedicine for years. Martin Flaherty, the managing director for the association of ambulance chief executives in the U.K., took the group to the next level with his insight into the next evolution of community paramedicine by presenting the findings from the 2005 report, Taking Healthcare to the Patient: Transforming the NHS Ambulance Service, and the 2011 report update, Taking Healthcare to the Patient.

Martin highlighted the NHS ambulance trusts are strained with 6–8% annual increase in call volume, with 10% of the calls being an emergency in nature and 90% requiring urgent care. To help manage this volume, the NHS Ambulance Trusts are implementing a 1-1-1 system in addition to the existing 9-9-9 system (their equivalent to our 9-1-1 system). The goal is for non-emergency callers to call 1-1-1 for less urgent calls, allowing the NHS to utilize more robust alternative care pathways and respond to those requests in a different timeframe.

The NHS is also evaluating several enhancements to their service delivery model, including developing more paramedics to advanced and specialist paramedic roles, improving the range of clinical assessment and clinical decision making skills to manage patients closer to home, and obtaining independent prescribing for ACPs.

The next IRCP Roundtable will be held the week of Oct. 14, and hosted by the Council of Ambulance Authorities of Australasia, which includes Australia, New Zealand and New Guinea.