David Glendenning Presentation Title

Transcription

1 David Glendenning Presentation Title Education Coordinator Emergency Medical Services

2 New Hanover Regional Medical Center

3 New Hanover Regional Medical Center Emergency Medical Services

4 Our EMS Reality In has become the safety net for non-emergent healthcare. 29% of requests are non-emergency Top 10 users of our system accounted for 702 EMS responses ED turn-around-times increasing The questions: Are we providing the right level of services? Are we delivering these patients to the most appropriate facilities?

5 Early CP Success CHF Beta Patient 56 y/o male CHF patient Admitted to NHRMC five consecutive times weekly for an average cost of $14, per week 911 use on every instance Referred to us by case management We agreed to partner with Hospice 5

6 First Time Visit by CP discoveries Pt didn t understand how to inject IM Lasix Lasix doses were crystalized in refrigerator Medications were duplicated Lighting in bathroom was broken Several high sugar/high salt foods in kitchen Bi-pap unit was not being utilized and worn backwards when attempted Anxiety PRN meds not being utilized properly around the same time he tended to call 911 6

7 Results Post CP visits Lighting was fixed via building staff New Bi-pap mask and fitting Medications reconciled Pt utilized PRN Ativan as needed Support from family and friends increased Working relationship with Hospice Rn s Depression decreased Pt began to take short trips from his apartment Diet improved Was able to administer IM Lasix and handle his crisis twice at home Over 7 months, he was admitted twice for anemia Made all of his scheduled medical appointments QUALITY OF LIFE IMPROVED 7

8 CHF Beta Patient Results 25 EMS TRANSPORTS PRE & POST COMMUNITY PARAMEDICINE PROGRAM Pre Post

9 Financial Impact on the Hospital $400,000 Annualized Hospital Charges Pre & Post Community Paramedicine (Patient had no ED Visits without Inpatient stay) $350,000 $339,199 $300,000 $250,000 $200,000 $150,000 $118,454 $100,000 $50,000 $- Pre Post 9

10 Program Description Our Community Needs Reduce unnecessary utilization and ED visits for our familiar faces/familiar places. - Proactively manage care and serve as a trained navigator of community resources Improve NHRMC s readmission rates. - Care for high risk patients within 50 miles of our hospital Partner in healthcare system integration & care coordination. - Work in cooperation with other stakeholders/medical providers 2.5 FTE s carry out the program s operations. - Home visits consist of clinical and home safety assessments, medication reviews, and in some cases, treatment of acute medical needs

11 Filling A Gap In The Plan Of Care Paramedics already have a good understanding of the CHF patient in crisis Under existing scope of practice, they can administer many medications needed With enhanced training, they learn more about the disease process including: medication reconciliation proper diet and nutrition weight management cardiac rehabilitation mental health needs 11

12 NHREMS-CP Provider Education Total: 308 hours of didactic and clinical education 64 hours classroom (via web classroom with other state programs) 48 hours online modules 196+ hours clinical education Hospice rotation (inpatient, home visits, social work, clergy, etc ) Cardiovascular rotation ( inpatient, office, procedures, etc..) Behavioral rotation ( CIT training, inpatient, home visits, etc ) Internal rotation ( inpatient, team focus, detailed H&P, etc ) Pharmacy rotation ( medication reconciliation) IV access lab ( specialized access including central lines, ports, etc ) Nutrition Free clinic (serving internal needs for indigent population) Case management, social service, etc.. Retooling a new kind of clinician

13 NHRMC CHF Re-Admission Reduction Strategies Re-Admission risk assessment Roadmap to discharge IP Case management visit Pharmacy bundle Schedule follow-up appointment Transition calls Community Paramedic visits 13

14 How Do We Follow This CHF Patient After Discharge? Do our patients truly understand discharge instructions? Do they have the support at home? Will prescriptions be filled? Will they make it to scheduled appointments? 14

15 6 Month CP CHF Readmission Data 77 patients 9.3% readmission rate at pilot close (national average 22.6%) Quality of life increased Creation of bed availability; 30-day readmission penalty avoidance; cost avoidance for low/no payors

16 CP Results: First Medicaid Patients $250,000 $200,000 $235,677 Community Paramedicine ED Familiar Faces Patients Patients with Medicaid Primary & Medicaid Secondary Annualized Charges Inpatient Visits ED Visits 25 $150, $100, $50,000 $55,179 8 $63, $- Pre In Program Post 12 months pre-program

17 Proven Success = More Grant Funding $900, in additional grant funding Reports from the Community Paramedic grant #1 verified success Comprehensive readmission avoidance package Included creation of Pharm-D, 2 Case Managers, resources, and 2 additional Community Paramedics 17

18 New Hanover Regional EMS CP Program s Future Continue the hospital based focus for the improved health of the populations Continue to build partnerships with other services in the community Population Health Management through data driven education All Cause Readmissions o o o o Stroke (900 admissions a year) Pneumonia Chronic Obstructive Pulmonary Disease Post surgical discharges (CABG) 18

19 Impact From Better Managed Care

20 Questions? Terry McDowell, Administrator Rick O Donnell, Director/Chief [email protected] Timothy Corbett, Administrative Manager [email protected] David Glendenning, Education Coordinator [email protected]