“Home Visit: Transition to Home Now Safer”Kevin Sipprell MD

Julie Burkhardt MS, RN

RARE Action Learning DayThursday, 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– 2 Volunteer

• 10,000 calls– 30% non-transport– 18% interfacility

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?

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

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

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

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

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”

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