home visit: transition to home now safer kevin sipprell md julie burkhardt ms, rn rare action...
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“Home Visit: Transition to Home Now Safer”Kevin Sipprell MD
Julie Burkhardt MS, RN
RARE Action Learning DayThursday, November 8, 2012
Ridgeview Ambulance Service• 730 Sq Miles/7 counties• 130,000 population• 64 paramedics• 35 EMT’s• Ambulance Coverage
– 8 during the day– 5 overnight– 2 Volunteer
• 10,000 calls– 30% non-transport– 18% interfacility
Filling the Gaps
• EMS staffs for near peak utilization– There is significant hour to
hour and day to day variability
• There is inherent downtime in EMS
• What else can they do during this time?
Ambulance Offers Unique Skill Set
• Medically trained staff• Comfortable going into
people’s homes• Already in
community/service area• Proficient working with
algorithms• Frequently communicate
with providers• Assures no added expense
Gaps meet RARE…Project Goals and Strategies
• Enhance the role of the paramedic
• Reduce avoidable readmissions!
• Ensure discharge medication plan is the home medication routine
• Coach disease specific self-management skills
• Afford the patient a value-added experience
Implementation Activities• Identified 3 high risk
readmission diagnoses: CHF, PN, COPD
• Trained 4 medics as the core group; will roll out to additional medics as program expands
• Rolled out to RMC clinic patients/providers first; intend to add other clinic(s) in near future
Implementation Activities
• Educate patient prior to discharge of potential visit
• Schedule visit 48-72 hours post-discharge but prior to follow-up visit with Primary Care Provider (PCP)
• Acceptance of program and potential phone calls from medics by PCPs
Challenges & Outcomes• Patients must reside in RMC
ambulance service area• Notification of patients that
medics will arrive in an ambulance (alarm neighbors!)
• Visit length goal at 40”; currently 60” or more
• Restructured/refined checklists to only most essential elements to reduce visit to 40”
Lessons Learned & Suggestions• Change paramedics’
mindset from a role of treat/transport to that of a coach in self-care skills
• Coaching is likely much more effective in the home– Visualize foods re: sodium– Seeing weight chart/scale
• Med Reconciliation is bigger than world hunger!!– Med Discrepancies were
found on 83% of the visits
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