CEO Blog: Community Paramedics Improve Care By Reaching Patients Where They Are

March 12, 2014

In recent posts, we have used this space to discuss how the delivery of health care is changing at its most fundamental level. Hospitals that provide the best patient care, emphasizing how to keep people healthy rather than treat them when they are sick, will be the ones that succeed going forward, and we believe New Hanover Regional Medical Center is well on its way to becoming one of those hospitals.

A powerful tool we are developing, which is already benefitting patients, will help us transition to this future ideal. With generous assistance from The Duke Endowment, we have started a program of Community Paramedicine, an effort that matches the wonderful talents of New Hanover Regional Medical Center EMS with our hospital’s ever-increasing focus on preventive health in the community.

The "Community Paramedics" are trained specifically to work with patients in their homes or in the community before they have a medical emergency. These paramedics have completed rigorous medical training that allows them to handle an array of basic, primary health needs. The Community Paramedic is an extension of the health care team and will often act as a catalyst to connect patients to their physician at an earlier stage in a disease process. With this process in place, we can meet patients’ health needs immediately where they are, preventing unnecessary emergency room visits and hospital admissions.

The outcome is the dual benefit of reducing healthcare costs while also helping patients stay healthier so they can resume normal activities with work and family.

Our program begins in full this month, though we have piloted with numerous patients and have already seen tremendous success. It works by having our Community Paramedics, two full-time and one part-time, reach out to a variety of patients who frequently use our emergency or inpatient services.

We will carefully select the patients we believe fit the criteria for this program. They may include frequent visitors to the emergency room or frequent callers for ambulance transports. It may be patients who are frequently admitted to the hospital. Or it may be patients we have identified as being likely to readmit to the hospital once they go home.

Our visit with the patient begins with establishing a relationship. Many of these patients simply need a friendly face they can trust to call on before a health situation becomes an emergency. But the interaction is much more than a social encounter.

Community Paramedics are trained to help patients manage chronic disease by discussing signs and symptoms, helping them get an appointment to a doctor, and educating them on their medications to ensure all medications work together properly. They can assess the home environment for obstacles to good health or triggers that could cause a health danger to the patient, such as poor diet contributing to diabetic complications.

They can perform many of the services typically done during a follow-up visit at the emergency room, such as wound care, suture removal or oxygen therapy for congestive heart failure patients. This complements services they already provide, such as echocardiogram interpretation, performing lab tests in the field, and administering more than 50 medications. We may eventually be able to assess patients at skilled nursing facilities who have fallen and confirm the patient has not sustained major damage, allowing the patient to remain at the facility and preventing an unnecessary trip to the ED.

Community Paramedics are trained to recognize and de-escalate disruptive behavior by patients in mental health distress, allowing patients and families an opportunity to stabilize at home and later seek the appropriate level of care with the right provider.

How does this service look to the patient? Let me give you two examples:

In early 2013, we noticed a young woman had made 22 inpatient visits and 10 emergency department visits in a 12-month period, all relating to a manageable chronic disease. Our Community Paramedic established a relationship with her last fall. The paramedic is her friend and confidante on all things medical, and the two frequently call just to catch up. Since October, the patient has had two inpatient admissions – and none in 2014.

Another man from our list of most frequent ED visitors had 20 visits over a 12-month period. Since our program started a relationship with him in mid-January, he has had none.

The savings from reducing utilization from even a handful of patients is significant and will go a long way toward reducing our healthcare costs in the future. But to me, what’s important is that these people have added quality to their everyday lives simply through regular contact with a caring health professional.

A major factor working in our favor with this program is that NHRMC operates the county’s Emergency Medical Services. From day one, we already had a working relationship between the two primary partners in this type of program, able to share medical records, strategic priorities and needed resources. Only three hospitals in North Carolina operate their county’s EMS programs, so most new programs have to work to establish a relationship with the other partner. We already had one. Add in existing partnerships with NHRMC Home Care and Lower Cape Fear Hospice, and we already had the major relationships any Community Paramedicine program would need to get started.

Though we are new to this program, these advantages have already helped us to become somewhat of an industry expert, sharing best practices throughout the region and even nationally, and helping train staff from other programs. We have even taken a role in advocating how Community Paramedicine needs to become a service covered by insurance, to include the state’s Medicaid plan, to help sustain the program going forward.

It's not often that you can be an industry leader the moment you begin a program, but the advantages we have by operating New Hanover Regional Medical Center EMS gave us a unique opportunity with the Community Paramedicine program. It’s an opportunity we intend to develop to the fullest for our patients’ benefit.