Navigating Patients through Healthcare

Many EMS agencies strive to improve the service they provide every year. MedStar Mobile Healthcare (formerly MedStar EMS) in Fort Worth, Texas, has taken that model and jump-started it into the 21st century by transitioning itself into a state-of-the-art mobile healthcare agency.

Patient Navigation
Traditionally ambulance services have simply responded to calls and transported
patients in the usual, “You call, we haul” medical transport model. “We believe that the future of MedStar, and the future of our industry, is to navigate patients through the healthcare system,” says Matt Zavadsky, MedStar’s director of public affairs. MedStar has streamlined their mobile service to now be the envy of EMS.

The process starts with the traditional 9-1-1 call, which is screened through their emergency medical dispatch process using the National Emergency Medical Dispatch System. If the call is deemed low acuity, it’s sent through their 9-1-1 Nurse Triage system, allowing a specially trained nurse to work with the caller to get the most effective and efficient treatment.

“If the caller has a toothache, or foot pain, or cold symptoms, we work with them to get an appointment with their doctor, or to get them to a clinic or urgent care center,” says Zavadsky. “So if they have a doctor, we get them to their doctor. If they don’t have a doctor, we get them connected to one. That coordinated care is better for the patient.”

In some cases, a MedStar’s nurse may advise the caller to stay home and give them instructions on how to care for him or herself. The nurse will then follow-up with a phone call later in the day, or later in the week. “Too many patients call 9-1-1 and use the emergency medical care system as their source of primary healthcare and that’s inconsistent care for the patient,” Zavadsky says. “This is a much kinder and gentler way to help patients.”

Patient Identification
MedStar also works with area hospitals to identify and reach out to frequent 9-1-1 callers, using mobile health medics who aren’t assigned to ambulances. In many cases the caller simply doesn’t know where or how to obtain regular healthcare. “We work to get them connected to a physician or into some type of public clinic care system,” Zavadsky says. “We find out what their eligibilities are for those types of programs and then get them enrolled, essentially transitioning them from using 9-1-1 all the time to having a regular source of medical care.”

The agency also works to identify those patients who are at risk for readmission to the hospital for chronic conditions, such as congestive heart failure. The agency works with the patient and the patient’s primary care physician to make sure they are able to care for themselves at home.

Social issues can also drive many patients to visit an emergency department when they think they have nowhere else to turn. “We work with hospitals where the emergency department physicians may identify a patient who might normally be admitted for overnight observation, not necessarily because of a clinical need the patient has but because of a social issue or an environmental issue at home,” Zavadsky says. “Something the physician is just unsure about. Instead of those patients being admitted to the emergency room overnight, or over the weekend until they can see their follow up doctor, the physician refers those patients to our community health program. We can help monitor the patient at home and provide any resources they might need until they get to their doctor’s appointment, avoiding the cost of admission to the hospital.”

Perhaps surprisingly, MedStar also assists with hospice needs, especially for families at risk for panicking and calling 9-1-1 in the final hours of a terminally ill loved one’s life. “If they can’t reach their hospice nurse, they can call us and we’ll send a mobile health medic to see them,” Zavadsky says.

MedStar also registers the family with their 9-1-1-dispatch system so that in the event that they call, their hospice nurse will be notified. “We will send our mobile healthcare medic along with the ambulance to help the family through the crisis, provide the patient with medication to make them comfortable if necessary, and release the ambulance from the scene,” says Zavadsky. The mobile health medic will then wait with the family until the hospice nurse arrives.

MedStar has also moved into the industrial space by helping local corporations and companies determine how to respond to minor industrial injuries. They assist companies in determining whether an employee needs to go to an emergency department, a clinic or just needs to go home. This approach helps the injured patient while also preventing other employees from having to leave the facility to take people to the hospital.

Changing the Community
The programs have received enthusiastic approvals. To date, the agency has hosted 45 communities from 24 states and four countries to observe the process first-hand. MedStar also has been asked to go to communities to meet with and educate stakeholders on how such a program can get started in their area. “We bring our data to show this actually works,” Zavadsky says. “This is not a unicorn. This is real, and we show them the data that proves it: the use data, the cost data, and the patient satisfaction data for these programs.”

To succeed at such an ambitious undertaking, MedStar has had to gather many agencies and personnel around the table. They accomplished this by creating a Care Coordination Council. The council meets monthly and is comprised of representatives from the six area hospitals, plus case managers and social workers. Additionally, community organizations, such as the United Way and the Area Agency on Aging, are also invited to the table. “The group expands every time we have a meeting,” Zavadsky says. Discussions center on specific
patient needs and how these community health representatives can find the solutions and services for these individuals. “We discuss how we can bring these patients the services they need, so they don’t have to rely on 9-1-1 or the emergency care system for their healthcare needs,” Zavadsky says. “Sometimes it takes a village to help these patients.”

MedStar is also actively changing some of the EMS paradigms to community care by developing such programs as the 25-in-5 Hands Only CPR Program, which was launched in 2011. The initiative’s goal is to train 25,000 people in the community in five years to deliver chest compressions, hands-only CPR. So far, 9,000 people have been trained.

Making the bold decision to eliminate lights-and-siren transports while CPR is in progress was another paradigm-shifting decision by the agency. “The back of an ambulance is a difficult environment to do good chest compressions, especially when the ambulance is weaving in and out of traffic,” Zavadsky says. “It’s dangerous for the crew and motoring public. So to provide the best possible CPR, and to make the transport of that patient the safest possible, we don’t use lights and sirens when transporting someone to the hospital.”

MedStar has even been working with local organ and tissue donation firms in Fort Worth by having EMS crews who pronounce someone dead on the scene ask the family about tissue donation. “We will ask the family, “˜Has your loved one considered tissue donation?’ And if they haven’t, we ask “˜Would you consider tissue donation?'” Zavadsky says. “We will make the call from the living room to the organ donation agency to see if they want to walk the family through the potential tissue donation process for our community.”

Making a Difference
The 350 employees that make up the self-revenue-generated agency are motivated as a team to make a difference in the Fort Worth, Texas, community and beyond. Zavadsky says each and every employee is not satisfied with the  status quo. Each wants to do the little bit extra that ends up having a big and lasting impact.

“They are constantly looking for the next innovation to improve our community’s health,” he says. “And they are constantly looking to improve the development of  our industry. We want to become more of a healthcare provider instead of just a transportation method.”

No question, MedStar Mobile Healthcare is transforming the way EMS is delivered. It’s an agency that is on the move and moving forward.

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