EMS World

FEB 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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24 FEBRUARY 2019 | EMSWORLD.com COVER REPORT: MIH IN BALTIMORE health for enrolled patients (e.g., housing issues, social-work needs, and paying for medications). Program #2: Minor Definitive Care Now (MDCN)—MDCN provides low-acuity 9-1-1 callers the option to receive immediate on- scene care by an ALP and a community paramedic. For all emergency calls BCFD dispatches a normal 9-1-1 response; for certain calls (e.g., ankle injury due to fall, toothache, simple laceration) the MDCN team (a paramedic and an ALP) will also respond and participate in the assessment. If the patient consents into the program, the team provides a thorough evaluation and definitive outpatient care on scene while other units return to service. The team arranges follow-up for the patient in coor- dination with the operations center. The program was launched October 10, 2018. Benefits and Results The BCFD identified as its program objec- tives not only responding to medical, social, and environmental concerns within the 30-day enrollment but also reducing hos- pital readmissions, ED visits, 9-1-1 calls, and overall healthcare costs. Upon preliminary analysis the results have shown a 30-day readmission rate among THS patients approximately 2% lower than the expected risk-adjusted readmission rate at UMMC. A robust study has been designed to accurately evaluate the effect of the program on these out- comes with a focus on patient satisfaction. Overall patient satisfaction for the program averaged 9.7 out of 10. As of November 2018 MDCN had suc- cessfully treated seven nonemergency patients on scene, avoiding the need for ED transport. The success of the MDCN program will be determined by collecting, analyzing, and reporting data on the fol- lowing outcomes: • Number of EMS ED transports; • Unscheduled re-entry into the health- care system (associated with original EMS complaint) within a 72-hour period; • Total call duration for MDCN calls; • Changes in average ED wait times relat- ed to implementation of the MDCN pilot program; and • Patient satisfaction survey results. From a funding standpoint, Maryland S.B. 682 was signed into law May 2018. The law provides the opportunity, if value is demonstrated, to allow EMS to bill/receive reimbursement for healthcare services pro- vided in a patient's home or other location whether or not the patient is transported to a hospital ED, and also for transporting patients to healthcare destinations beyond the ED (e.g., primary care physicians, sub- stance treatment centers, urgent care). Overcoming Obstacles To overcome challenges, the BFCD continu- ally evaluates procedures, patient safety and health outcomes, provider feedback, patient satisfaction, and communit y engagement. The biggest obstacles have arisen from legal issues raised in developing a program between a medical system and a busy municipal government. This public-pri- vate partnership has successfully navigated these obstacles to serve the community. Another obstacle has been documen- tation. Leaders decided to use the same charting system as the UMMC: Epic. Doing so has ensured accurate and up-to-date data and improved understanding of inpatient and out- patient care plans for optimal management. Baltimore citizens have significant social and medical needs.

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