ClickCare Café

Why Community Paramedics are the Next Big Thing You've Never Heard Of

Posted by Lawrence Kerr on Tue, Nov 29, 2016 @ 10:13 AM

olderwoman.jpgWe are passionate about thoughtful, effective medical care, especially new models that work in complex situations. That's why we are big supporters of WOCNs. It's why we love these Long Term Care programs. And it's why we started ClickCare.

As we all know, long term care and care for chronic conditions is only increasing as a percentage of the total medical field. So solutions that don't treat chronic problems as acute but rather treat them as the holistic, long-term conditions that they are -- have a lot of potential to be transformative.

A new example of this kind of out-of-the-box thinking caught our eye recently, for just these reasons. It's a model called Community Paramedics or "mobile integrated health care." The model is structured to avoid frequent trips to the emergency room by folks who could be better treated at home. So when an emergency call is made, and paramedics respond, the paramedics are trained to connect with physicians via tools like videoconferencing on an as-needed basis. That usually means additional training, a team approach, and an emphasis on preventing unnecessary transport.

The New York Times quotes Dr. Karen Abrashkin, one of the leads in a Community Paramedics program, as saying, “A lot of what’s been done in the E.R. can safely and effectively be done in the home... the hospital is not always the safest or best place to be.” So the Community Paramedics programs focus on treating patients with at-home visits by paramedics, avoiding E.R. visits.

The justification is pretty simple. Emergency rooms often lead to readmissionsincreased length of stay, deconditioning, rehab and physical therapy to regain mobility, hospital-acquired infections, and delirium. These things are true with most populations, but especially true for patients with complex problems or those who can be treated/triaged instead of becoming super-utilizers of emergency rooms. 

For the patients, the consequences of this kind of emergency room visit can be deadly or contribute to a decreased quality of life. Of course, on "another side of the table", these issues also put hospitals -- especially in a pay for performance system -- under huge amounts of financial pressure.

Community Paramedics challenge the typical thinking of "we need to do this just to be safe." But "just to be safe" can kill. So we think this kind of thoughtful approach could be hugely impactful as a model. 

We would argue that videoconferencing in these situations is ultimately not the best way to go, since it necessitates physicians to be immediately available, makes the flow of treatment with the patient more challenging, and cannot be used later as a teaching case. We believe that especially when you are working with teams across the continuum of care, it's really important that consults can be done asynchronously using a healthcare collaboration tool like hybrid store-and-forward telemedicine.

It makes financial sense and it keeps people in their homes, healthy and mobile, longer.

 

Learn more about how healthcare collaboration tools can support innovative models like this one:

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Tags: long term care, care coordination, healthcare collaboration, emergency first responders, emergency medicine

Medical Collaboration Tips From a Typhoon-Ravaged Hospital

Posted by Lawrence Kerr on Fri, Mar 07, 2014 @ 08:59 AM

typhoon resized 600

Collaboration in Response to Disaster

 

It's hard to imagine the devastation of a large-scale disaster like that of Typhoon Yolanda in November of last year.

As the New England Journal of Medicine reports, an Israeli medical team that arrived in the days following the storm found a pretty desperate situation. Throughout the Philippines, more than 5,000 people were confirmed dead and 22,000 were still reported missing. Upon reporting to the hospital, where the Israeli team was to work, they found 120 hospitalized patients, no electricity, no running water, and an Operating Room with a staff of 2.

The World Health Organization guidelines suggest that a team like this one should set up their own hospital, not integrating or collaborating with teams on the ground. But the Israeli team had a strong sense that an unintegrated path wouldn't be the best course of action. Within hours, they worked with the Philippine hospital and local resources to create an integrated plan for medical collaboration.

And within 10 days, this collaborative, transnational team of medical providers deftly dealt with 2,686 cases.

What allowed them this kind of success in such difficult conditions?

This brave team gives medical collaboration takeaways anyone can learn from:

  • Accepting resource limitations. We all have limited resources, and sometimes these limitations can seem insurmountable. For this team, however, giving up was not an option, so they accepted their resources and did whatever they could within them. 
  • Being willing to go against protocol. Despite the WHO guidelines, this team decided to collaborate and integrate. It was a risk, but it seemed like the right thing to do for the patients, so they went with it. Their success was their reward.
  • Open communication and quick decisions. One of the most important pieces of this story is the way that decisions were made quickly, but with transparency, and good communication. Sometimes people think that communication has to be sacrificed for speed. But this high-pressure situation shows that good communication actually facilitated a speedy response.
  • Clear lines of responsibility. We've covered the ways that clear lines of responsibility decrease length of stay and drop readmissions. Similarly, having very clear roles and responsibilities helped this team quickly triage and treat, without duplication or gaps in care.

As the team said, reflecting on the experience: "Following a cooperative model may pose some challenges… In this instance, however, by relinquishing our well-established habit of operating as a highly independent unit, we found that, when feasible, a cooperative model can have additional and important benefits for the victims of a disaster."

 

For more medical collaboration stories and strategies, get our Quick Guide to Medical Collaboration:


ClickCare Quick Guide to Medical Collaboration

 

 

Image courtesy of ihhinsaniyardimvakfi on flickr.com, used under Creative Commons rights.

Tags: medical collaboration, medical responsibilities, care coordination, decrease readmissions, decrease length of stay, emergency first responders

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