Transcript Paramedics

Utilizing Advanced
Practice Paramedics to
Reduce Hospital
Readmissions
Presented by:
Kevin Yarrow
Senior General Manager
VITAS Innovative Hospice Care of Dallas
1
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
2
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
6
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.
10
Program Options
If 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
11
Pre-Implementation Steps
 Assist 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
12
Pre-Implementation Steps
Have 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 Steps
Hospice 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
16
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
17
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?
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