So what is a Community Ambulance program?

Community Paramedics try to Curb Hospital Re admissions and Non-Emergent 000 calls

Mobile integrated healthcare and community paramedicine [CP] could be making significant strides in areas across Adelaide. Although goals of CP programs will differ based on a Health direction, many if not most of them allow paramedics and nurses to perform assessments outside of the 000 system and then refer patients to non-emergent healthcare and social services in collaboration with patients, primary care provider SAAS, social workers and others who may contribute to healthcare decisions.

Our program had two goals: reducing 30-day readmission rates at hospitals, and reducing frequent, repetitive utilization of SAAS resources for non-emergencies where possible.

With most if not all our clients having no insurance, SAAS cover and only Medicare, the cost for ambulance provision was outside of their financial need, and some still have ambulance debits today.

Providing out of hospital readmissions within 30 days after discharge, cost savings to the healthcare system will likely be an outcome of our program success; however, the goal is to “test and evaluate new or expanded roles for healthcare professionals and new healthcare delivery,” as well as to link patients to appropriate healthcare and other services, ultimately leading to better health outcomes.

 REFINING GOALS

Goal 1: Curbing re admissions. In Adelaide, uninsured low income discharged patients from hospitals, mainly RAH had one of five diagnoses:

COPD:  chronic obstructive pulmonary disease,

  • Sepsis and pneumonia,
  • Poor health care in general
  • Diabetes

These conditions, we try to curb 30-day hospital readmission rates.

Goal 2: Reducing frequent users. The program’s other aim seeks to solve a problem familiar to many medical system: targeting frequent users of 000 for non-urgent needs who tie up valuable response and care resources, compromising SAAS ability to respond to acute medical emergencies.

Connecting these “familiar faces” with more appropriate and sustainable services rather than 000 and EDs is expected to free SAAS resources for emergency response needs.

PRE-IMPLEMENTATION CONCERNS

EMT service having worked in this area of lower social environment have a good grasp of the clinicians working in this field.

Our clients seen by community paramedics are the same or similar to patients seen through the 000 system: recently discharged patients whose conditions have exacerbated or a patient or family member fears has been exacerbated, exaggerated by their own unease about symptoms experienced away from a hospital setting.

Comparing the role of a community paramedic to a 000 paramedic, the workload is different in that we take responsibility for a client and his or her case. We spend a lot of time thinking on game plans for these clients, as opposed to 20 minutes on-scene time and 40 minutes total transport times.

When making forward progress with clients, there will be steps back. You we must be patient and able to adapt to our client’s situation. Usually it’s a waiting game. When your client is ready, then you can use your tools.”

 As found by other programs, communication between community paramedics and the client’s primary care doctor was identified as a crucial resource in facilitating appropriate follow-up care. If an emergent concern is identified at any time during a visit, 000 is activated and appropriate interventions are initiated by the community paramedic.

If an eligible client is homeless, the community paramedic attempts to engage the person at his or her last known location. Similar to post-discharge clients, assessments are performed that address physical condition and complaints, safety, dietary intake, medication compliance, social needs, and access to resources.

Successful referrals connecting the client with useful resources are essential in helping our clients improve their health and address their non-emergent needs in an appropriate and cost-efficient way.

We are surprised how frustrating it is to navigate someone who needs or accepts help through the healthcare system—especially for substance abuse treatment. The current system has a lot of red tape, paperwork and lag time to help someone in need and there’s no instant help and that’s frustrating, especially for someone who finally accepts help

 CONCLUSION

EMT Ambulance is proud of its ability and reputation for delivering excellent pre hospital care. Furthermore, we know SA Health is excited to have the opportunity to improve the community’s health. Although cost-savings and decreased unnecessary resource utilization will benefit the overall healthcare system, the true value of this program is connecting individuals with safe and appropriate healthcare.

Summarizing the program’s impact is not only helping people who are slipping through the healthcare system’s gaps, we’re also connecting local resources to one another.

Networking is 80% of our job and the other 20% is listening to our client. Community paramedics, Community Ambulances are the some of ‘the boots on the ground,’ helping those with needs—from medical questions, connections to resources and to just be present—to show that someone out there cares.”

Like to know more, please contact us.