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.

Issue link: https://emsworld.epubxp.com/i/1071873

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Page 27 of 53

26 FEBRUARY 2019 | EMSWORLD.com COVER REPORT: MIH IN BALTIMORE routed via the EMR by the MIH pharmacist. Furthermore, if a patient is referred to a UMMC site (emergency department, urgent care, intensive ambulator y care clinic, heart failure clinic) for immediate medical evaluation, the receiving provider can see the most recent vital signs, care provided in the home and/or on scene, and any information related to treatment. Additional challenges arose with the coordination of resources and communi- cation between the operations center and the rest of the MIH team. Teams meet in person with patients roughly five times over 30 days. Due to staffing constraints, the same team members are not always able to visit the same patient. It is essen- tial that patients develop a strong trusting relationship with our program as a whole. The team has added thorough QA review systems to ensure delivery of all requested resources. Adjusting program schedules as well as the layout and workflow of visits has helped support overall operational capacity. Finally, the team identified that patient care plans are dynamic and need to be reevaluated at multiple points. Some resources initially expected to be easy to obtain have in fact proven nearly impos- sible (e.g., furniture, home maintenance and repairs, nutrition education). Identi- fying patients' needs is easy, but resolving them can take time and patience. Some patient needs cannot be met within their enrolled 30-day time frame. Next Steps Currently we can provide effective health support to the patients we reach within the THS and MDCN programs by helping them identify how best to manage their own care. To increase our effectiveness, however, it is imperative that we reach more patients. A long-term goal is to partner with other city institutions. Inclusion of addi- tional facilities will expand not only our geographical area but also our access to resources. A sh o r t-ter m go al fo r ex p an ding resources includes discontinuation of an ALP in the patient's home. Instead we'd like to have them join the team via Zoom video call technology. The eventual goal is to provide a two-paramedic model also utilizing Zoom, which would enable col- laboration of multiple hospitals and the fire department. Our next step for MDCN is to expand the service area both east and west. Addition- ally we will have to increase the call types to which MDCN responds. Currently we respond only to alpha-level calls (e.g., ear- aches, dental issues, simple lacerations). We rely on the accuracy of the caller as well as the call-taker. It's not uncommon for callers to inadvertently provide inaccurate information, necessitating a change in the level of service at the scene. MDCN crews have the required knowl- edge to read available call information (via CAD) and decide whether the patient meets designated criteria. Allowing para- medics who have responded emergently to a scene to refer patients into the MDCN program is another option. We are working with the Maryland Insti- tute for Emergency Medical Services Sys- tems (MIEMSS) to improve our operations to further ensure safety, improved health, and value of our efforts. An area of discus- sion with MIEMSS, and actually a goal for our program, is the use of telemedicine to assist in the evaluation of patients in the THS program. Lastly, as the safety and effectiveness of the program is con- firmed, our goal is to operate with teams of paramedics instead of our current RN/ PM model. Another option for MDCN is to enable paramedics responding to a scene to refer patients into the MDCN program. Lessons Learned EMS is evolving rapidly as evidence-based Patients must develop a strong trusting relationship with the program as a whole.

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