By Steve Buist
The Hamilton Spectator
ONTARIO, Canada — A $145,000 pilot project inspired in part by The Spectator’s Code Red series is helping Hamilton’s Emergency Medical Services provide better and more comprehensive treatment for the types of patients who often fall through the cracks of the health-care system.
The funding has allowed the city’s EMS to create an electronic referral system linked with the Community Care Access Centre so that patients can be better matched with the health and social resources they might need instead of simply ending up in a hospital emergency department.
The goal of the project is to reduce demand in hospital emergency rooms, which ultimately reduces costs for the taxpayer.
“We’re looking at decreasing the overall call volume, especially for those repeat patients who are continuing to use EMS as their gateway to the health-care system,” said Justin Pyke, the EMS project leader.
Last year, Hamilton’s EMS responded to 67,000 calls, including about 16,000 calls where the patients either refused or didn’t need a trip to the hospital.
“In listening to the paramedics and reading the Code Red reports, it became increasingly apparent to us that often the people who are refusing to go to the hospital have called us because they have some other need, not necessarily to go to the hospital,” said Brent Browett, director of Hamilton’s EMS.
“The paramedic arrives and helps them with the other need, and sometimes we do that well, sometimes we don’t.”
The Code Red health mapping project showed strong connections between health and poverty in Hamilton. The seven-day series published last April found huge differences in health outcomes between Hamilton’s best and worst neighbourhoods.
Data showed a 21-year difference in life expectancy across city neighbourhoods.
“I spent 20 years working on the street, and like any other veteran paramedic, I could have closed my eyes and painted pretty much the same picture as Code Red,” said Browett. “After decades of seeing that same continuation, it’s become for us a pent-up desire to do something different.
“The other component that Code Red painted for us is it re-emphasized that health is not about health care only,” Browett added. “It’s about the broader health of people and the determinants of health.”
The pilot project now allows paramedics to be the first trigger point in helping refer patients to other services.
“Previously, the only way that they could be referred to those services was through the hospital and that was one of the things we identified wasn’t happening on a consistent basis,” said Pyke. “So those followups weren’t happening and that vicious circle of release from hospital and then readmission just carried on.”
As the first responders on the scene, paramedics are uniquely positioned to observe the circumstances in a home that may have led to the problem. It could be anything as simple as trip hazards that caused an elderly person to fall, to rotting food and unsanitary conditions or other social problems.
“That’s something the emergency room staff would never see,” said Pyke.
“They treat the presenting problem and don’t see the circumstance that’s contributing to this vicious circle of readmission.
“The paramedics have that insight into the situation and many times it’s those things they’re seeing on the scene that are stimulating the referral.”
According to Pyke, early data from the project shows that an additional 40 per cent of patients - about one a day, on average - are getting referrals who wouldn’t have received a referral through the hospital alone.
The funding was provided by the Hamilton-Niagara-Haldimand-Brant Local Health Integration Network to help cover the cost of developing an in-house education module for paramedics and the electronic referral system. Every paramedic in the service has been given the training.
“We open up 67,000 doors a year,” said Browett.
“There probably isn’t any other city service that has that kind of opportunity.
“People call us and invite us into their house, so we have this unique opportunity to see those determinants of health and what needs to be done here to improve the quality of life.”
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