Issue link: https://emsworld.epubxp.com/i/336320
16 TRANSITION OF CARE Implementation We developed a two-hour training module for the EMTs, which includes approximately one hour of didactics and brief simulations of the two interven- tions included in this program. The EMTs were frequently inter- viewed for feedback during the initial training sessions and con- tributed significantly to both the design of the checklists and the training itself. The initial train- ing sessions were performed in person, but an online training module has recently been devel- oped that will allow us to com- plete the training of 100 provid- ers in the near future. Those al- ready trained have begun per- forming the interventions. The implementation pro- cess has resulted in numer- ous interesting anecdotes and many small discoveries. Two worth sharing have to do with what healthcare transformation looks like on the ground level. First, each encounter in which the EMT attempts to communicate with the hospi- tal to address an issue with dis- charge instructions has the po- tential to be transformative. Since this is a new and more healthcare-oriented role for the EMT and because post-dis- charge care has not historically been a major focus, hospital- based healthcare workers (phy- sicians, nurses, social workers) have highly variable responses and sometimes require substan- tial orientation to the program. Second, while most dis- charge instruction education is provided to a patient or family member, the person present when the EMT transports a patient home is often a home health aide (HHA) who isn't updated regard- ing the patient's condition or new treatment instructions. Ensuring the HHA understands the dis- charge instructions may be piv- otal to the prevention of return ED visits and readmissions. Evaluation and Dissemination To evaluate the efficacy of the program, the project coordi- nators are performing two-week follow-up phone calls. We as- sess patient and provider accep- tance, the number and types of fall hazards discovered, the rate at which fall hazards are being removed, and the rates and types of gaps in understand- ing of discharge instructions. A select number of pa- tients also receive a second- ary home visit by a commu- nity health worker to validate the EMT assessments and re- view the accuracy of the data received by the follow-up calls. We hope to ultimately com- pare the rates of readmissions and return ED visits among pa- tients who received the inter- vention to those who did not. We look forward to shar- ing the results of the Trans- port PLUS demonstra- tion project in 2015. Thanks to the following people for their contributions to this manuscript: Nadir Tan, BA, Glenn Youngblood, BA, EMT-P, Lynne Richardson, MD, Corita Grudzen, MD, MS, Kevin Chason, DO, & Ula Hwang, MD. Integrated Healthcare Delivery July 2014 www.ihdelivery.com Kevin Munjal is a board-certified emer- gency medicine physician who completed an EMS fellowship with the New York City Fire Department (FDNY). He is the founder and chair of the NY Mobile Integrated Healthcare Association (NYMIHA), an organization seeking to empower EMS providers to play a larger, more integrated role within our healthcare system. He is the associate medical director of Prehospital Care and co-chair of the Mount Sinai Health System EMS Committee in New York. He is an accomplished and prolific aca- demic researcher funded through both the National Institutes of Health and the Center for Medicare & Medicaid Innovation for his work in community paramedicine. His recent JAMA paper advocating for realign- ment of EMS payment policy received significant notoriety. Hugh Chapin, MD, EMT Hugh Chapin recently completed his medical degree from St. George's University and is currently the project manager for Transport PLUS based out of the Department of Emergency Medicine at the Icahn School of Medicine at Mount Sinai. He also earned a Masters of Science in Biomedicine at the Johannes Gutenberg University Medical School in Mainz, Germany. He is a fellow for the NY Mobile Integrated Healthcare Association and is actively involved with the growing field of community paramedicine. He remains an active EMT in New York City. Kevin G. Munjal, MD, MPH Disclaimer: This article's contents are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centers for Medicare & Medicaid Services. REFERENCES 1. Coleman EA, Berenson RA. 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