N.C. community paramedicine started with grant
The two-year grant put two full-time community paramedics on the street for preventive and follow-up patient care
By Mike Voorheis
The Star-News, Wilmington, N.C.
WILMINGTON, N.C. — Some patients take ambulance rides to New Hanover Regional Medical Center more often than they get their hair cut. In 2013, 10 patients accounted for 702 EMS calls.
With the mileage they rack up, you'd think they were earning frequent flyer points. But there is no reward for ambulance use. In fact, it's a burden on the hospital.
The ambulance miles, the devoted staff time and the delays in treating other patients all cost the hospital money. And high readmission rates, as defined by the Affordable Care Act, lead to lower reimbursement rates.
"The majority of those calls are non-emergencies," said Tim Corbett, an administrative manager at NHRMC EMS. Instead of buying and staffing more ambulances, NHRMC instituted a novel concept — the community paramedic.
NHRMC expects its community paramedicine program, funded through a two-year grant from the Duke Endowment, to help solve the "familiar faces" dilemma. The program brings paramedics to the patients before the patients have a reason to call them.
Community paramedics arrive at a patient's home in an understated Ford Escape stocked with medicine and paramedics' tools.
"It helps us blend into the community," Corbett said. "We want people to feel comfortable."
Though familiar faces were some of the high-priority cases, the emphasis has now shifted to patients with cardiovascular disease. NHRMC's first two full-time community paramedics, Matt Stevens and Sarah Rivenbark, often introduce themselves to patients who are still recovering on the eighth floor after heart surgery at NHRMC.
Then they schedule an appointment to visit with the patient at home. Inside the house, the paramedics assess the patient through standard medical evaluations. But they also do much more.
They scan the house for trip hazards and make sure smoke detectors are installed.
"Our community paramedics have built-in detective skills," NHRMC EMS education coordinator David Glendenning said. A loose rug in the family room or poor lighting in the bathroom could contribute to an accident later.
Because they have more time available than doctors do, they are also able to ensure that medical instructions are understood and followed. They check to see if patients are taking the proper medications, all of the proper medications and nothing but the proper medications. Sometimes they provide pill reminder boxes. They also make sure patients know how to properly use any medical devices, such as breathing masks, that were sent home with them.
The community paramedics help patients understand their dietary restrictions. Then they dig through the cupboards to point out unapproved foods. Sometimes, Rivenbark said, she educates patients about reading food labels. She explained to Louis Tatum, a heart catheterization patient, that a serving of soup might have 480 milligrams of sodium, but a can often contains two servings. That's double the sodium, Rivenbark pointed out, and must be avoided by someone on a low-sodium diet.
Stevens and Rivenbark even suggest recipes for patients, but only after they've made them themselves, Rivenbark said.
Tatum, 70, doesn't qualify as a familiar face, but he said he has been "hauled" to the emergency department four times in 20 years. Shortly after his release from a 10-day hospital stay earlier this year, he worried about numbness in his feet that occurred when he slept on his side. The paramedics called the doctor, who assured Tatum that common swelling was causing pressure on a nerve. Within two weeks, that situation improved.
Another important aspect of the duo's work is assessing the patient's support system. Many of those familiar faces did not have the physical or emotional support needed at home. For those cases, the community paramedics might recommend hiring a home health nurse or moving into an assisted living facility. And for those who have other needs, the paramedics have a lengthy list of programs to help them.
Stevens and Rivenbark had already worked together for 13 years before they parked their ambulance and embarked on a new path. The breadth of their skills reflects 300 hours of supplemental training.
"When we got off the ambulance," Stevens said, "I don't think we had an idea how much we were going to learn."
One other paramedic splits time as a community paramedic, and two more full-time community paramedics could be on board by fall, Glendenning said.
"It's a good program to be a part of," Tatum said. "It's good to know that these people are there to help you."
(c)2014 the Star-News (Wilmington, N.C.)
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