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“Home Visit: Transition to Home Now Safer”

“Home Visit: Transition to Home Now Safer”. Kevin Sipprell MD Julie Burkhardt MS, RN RARE Action Learning Day Thursday, November 8, 2012. Ridgeview Ambulance Service. 730 Sq Miles/7 counties 130,000 population 64 paramedics 35 EMT’s Ambulance Coverage 8 during the day 5 overnight

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“Home Visit: Transition to Home Now Safer”

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  1. “Home Visit: Transition to Home Now Safer” Kevin Sipprell MD Julie Burkhardt MS, RN RARE Action Learning Day Thursday, November 8, 2012

  2. Ridgeview Ambulance Service • 730 Sq Miles/7 counties • 130,000 population • 64 paramedics • 35 EMT’s • Ambulance Coverage • 8 during the day • 5 overnight • 2 Volunteer • 10,000 calls • 30% non-transport • 18% interfacility

  3. Filling the Gaps • EMS staffs for near peak utilization • There is significant hour to hour and day to day variability • There is inherent downtime in EMS • What else can they do during this time?

  4. Ambulance Offers Unique Skill Set • Medically trained staff • Comfortable going into people’s homes • Already in community/service area • Proficient working with algorithms • Frequently communicate with providers • Assures no added expense

  5. Gaps meet RARE… Project Goals and Strategies • Enhance the role of the paramedic • Reduce avoidable readmissions! • Ensure discharge medication plan is the home medication routine • Coach disease specific self-management skills • Afford the patient a value-added experience

  6. Implementation Activities • Identified 3 high risk readmission diagnoses: CHF, PN, COPD • Trained 4 medics as the core group; will roll out to additional medics as program expands • Rolled out to RMC clinic patients/providers first; intend to add other clinic(s) in near future

  7. Implementation Activities • Educate patient prior to discharge of potential visit • Schedule visit 48-72 hours post-discharge but prior to follow-up visit with Primary Care Provider (PCP) • Acceptance of program and potential phone calls from medics by PCPs

  8. Challenges & Outcomes • Patients must reside in RMC ambulance service area • Notification of patients that medics will arrive in an ambulance (alarm neighbors!) • Visit length goal at 40”; currently 60” or more • Restructured/refined checklists to only most essential elements to reduce visit to 40”

  9. Lessons Learned & Suggestions • Change paramedics’ mindset from a role of treat/transport to that of a coach in self-care skills • Coaching is likely much more effective in the home • Visualize foods re: sodium • Seeing weight chart/scale • Med Reconciliation is bigger than world hunger!! • Med Discrepancies were found on 83% of the visits

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