Issue link: https://emsworld.epubxp.com/i/336320
TRANSITION OF CARE 15 www.ihdelivery.com July 2014 Integrated Healthcare Delivery agencies and their providers are exploring new opportunities to achieve the long-held vision of a clinically integrated mo- bile healthcare service with re- imbursement linked to value. 6 The convergence of these two macro trends has en- abled a unique pilot proj- ect that seeks to demonstrate the value EMS can provide in the transition of care. Transport PLUS The Transport PLUS project is a collaborative effort between Mount Sinai Medical Center in New York City and Trans- Care, Inc., a private ambulance service provider. It's funded through a CMMI Health Care Innovation Award for the hos- pital's GEDI WISE (Geriatric Emergency Department Innova- tions in Care Through Work- force, Informatics, & Structural Enhancements) program. The project aims to determine the feasibility, acceptability and ef- fectiveness of using EMS pro- viders to perform a discharge instruction comprehension as- sessment and home fall haz- ard assessment for patients over age 65 and their fami- lies or caregivers; this is done during routine transports to the home following discharge from an ED or inpatient unit. Unlike most projects under the banner of "community paramedicine" or "mobile in- tegrated healthcare," this pilot utilizes the skills of an EMT- Basic, rather than a paramed- ic. While the majority of other programs involve removing pro- viders from traditional EMS roles and placing them in a ded- icated nontransport position, Transport PLUS emphasizes a "systems approach" to mo- bile integrated healthcare where providers of all types, and at all times, function in an integrated healthcare role. By expanding the EMT's role in healthcare without broadening the scope of practice, we hope to iden- tify EMTs as a valuable, unde- rutilized and often overlooked member of the continuum of high-quality healthcare delivery. The EMT conducts a struc- tured discharge comprehension assessment with the patient or caregiver sometime between their initial visit at the hospi- tal and the patient's settling in back home. The EMT must use his or her judgment to de- termine if the patient or care- giver is aware of the six basic pieces of information generally included in discharge instruc- tions. These have been adapted from the four pillars of transi- tions of care and include medi- cation self-management, fol- low-up instructions and knowl- edge of "red flag" symptoms. 7 The EMT helps by rein- forcing the written discharge instructions. If an element is not addressed in those in- structions, the EMT can fa- cilitate getting answers from the hospital or ED. They also conduct a home fall hazard assessment. This in- cludes a brief scan of the home or apartment for easily recog- nized fall hazards. An extensive literature search, including pub- lications from the fields of nurs- ing and physical therapy, gen- erated a list of 90 potential fall hazards in the home. A final list of 11 was compiled by prioritiz- ing the most prevalent hazards and identifying those easily and reliably assessed and modified by the provider, patient and/or caregiver. Those common haz- ards include throw rugs, wires/ cords, the absence of grab bars and obstructed walkways. We estimate these two in- terventions will add between 5–15 minutes to the total task time associated with these pa- tient transports. Given exist- ing unit utilization and capac- ity, this is expected to have a negligible effect on overall op- erations for the EMS agency. IHD_14-16_PostDischarge0714.indd 15 6/13/14 11:23 AM