1. Home Visit: Transition to Home Now Safer Kevin Sipprell MD Julie Burkhardt MS, RN RARE Action Learning Day Thursday, November 8, 2012

2. Ridgeview Ambulance Service 730 Sq Miles/7 counties 130,000 population 64 paramedics 35 EMTs Ambulance Coverage – 8 during the day – 5 overnight – 2 Volunteer 10,000 calls – 30% non-transport – 18% interfacility

3. 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?

4. Ambulance Offers Unique Skill Set Medically trained staff Comfortable going into peoples homes Already in community/service area Proficient working with algorithms Frequently communicate with providers Assures no added expense

5. 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

6. 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

7. 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

8. 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

9. 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