1 utilizing advanced practice paramedics to reduce hospital readmissions presented by: kevin yarrow...
TRANSCRIPT
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Utilizing Advanced Practice Paramedics to Reduce Hospital
Readmissions
Presented by: Kevin Yarrow
Senior General ManagerVITAS Innovative Hospice Care of
Dallas
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CALL 911!
Patients and Families often panic & call 911 when:
There is a sudden change in condition
Exacerbation of existing or new symptoms
Caregivers are unfamiliar with hospice services
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EMERGENCY DEPT.
Patients experience:
Long (and uncomfortable) wait times in the ED
Patient receives either palliative treatment they could have received at home, or unwanted aggressive treatment
Readmission to the hospital instead of their preferred setting for care (at home)
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ALTERNATIVE TO 911
If the patient had called hospice first:
Potential delays in on-call nurse arrival
Enduring uncomfortable symptoms for longer period of time
Additional delays after nurse arrives while waiting for medication, infusion supplies or other equipment to palliate symptoms
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Hospice/Hospital Impact
Lost revenue to hospice due to revocation for aggressive treatment
Emergency Department expenses paid by hospice if patent remains on service
Reputation affected for failure to manage patient ‘s care adequately at home
Potential penalties levied on hospitals for readmission within 30 days
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Paramedic Solution
Paramedic can often arrive faster than a hospice nurse
Paramedics are trusted by the public to resolve emergencies quickly
Paramedics carry medications (including IV therapy) and equipment not available to responding hospice nurse
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Common Response Symptoms
Respiratory Distress
Uncontrolled Pain
Unresponsive
Falls
Chest Pain
Bleeding
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Possible Interventions
Assistance with prescribed meds in home
Injury assessment and assist to bed
Nebulizer treatment
BiPap therapy
Aerosolized pain medication administration
Establishing an I.V. (hydration, meds)
Wound Dressing
High Flow Oxygen
Transport to hospice General Inpatient bed
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Paramedic Partner Candidates
Local government run paramedic service (i.e. Fire & Rescue)
Private paramedic & ambulance company contracted to provide 911 dispatch/response (i.e. MedStar or AMR)
Private ambulance company with paramedics on staff
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Getting Started
Identify the paramedic partner that best meets your need
Every jurisdiction (and county) may have their own rules governing paramedics
Customize the program to meet as many of your needs as possible given local regulations.
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Program OptionsIf the partner operates within the 911 call center, they may track your high risk for revocation patients in their system and notify you when your patient calls 911
Your partner may perform “pre-need” introduction visits to your patients
If your partner is outside the 911 system, you may still partner with EMS to defer to your paramedic partner in an emergency
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Pre-Implementation StepsAssist the paramedic service to develop a
palliative response protocol, or policy (to avoid transport to the nearest ED)
Develop a written agreement between your hospice and the paramedic company spelling out responsibilities, COP/HIPAA language and reimbursement for services.
Coordinate your Medical Director and the paramedic service Medical Director to establish order protocols
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Pre-Implementation StepsHave paramedic service extend
physician privileges to your hospice physicians
Develop a formulary for medications stocked on the paramedic’s response vehicle.
Establish a step-by-step protocol for dispatch, sharing patient information, communication during the response and written report for patient’s hospice chart.
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Pre-Implementation StepsHospice provides training for
paramedics on caring for end of life patients, palliative symptom management and available options to ED transport (Continuous Care, General Inpatient, etc.)
Create a training program for hospice teams
Develop information collateral that describes the program for referral sources and patients/families
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COP Considerations
Written Agreement with COP language (including hospice retains professional management of the patient’s care, background checks, etc.)
Paramedics (“Vendor”) educated by hospice
Hospice nurse is dispatched along with paramedic & updates Plan of Care
Hospice physician give orders to paramedic for on scene interventions
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Response Protocol Suggestions
Approval to dispatch required (assuming you are paying per response)?
Face Sheet, DNR, Med List (faxed or emailed to paramedic)
Provide name and cell of the hospice nurse enroute to paramedic
Provide MD on call name and number to obtain on scene orders
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Potential Challenges
Family also calls 911 (prior coordination with Fire Department EMS supervisor may allow for transfer of care)
If paramedic arrives in an ambulance (vs. a non-transport vehicle) the family may push for transport
Most private paramedics will not respond with “lights & siren” so arrival may be longer than family expected
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After the Call
Obtain paramedic’s written report. Review in IDT and keep in patient chart
Communicate response activity to the team (if after hours) for follow-up
Communicate response outcome with patient’s Attending and/or other physicians
Track responses and share success rate.
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Questions?