For some people, there’s nothing casual about suffering a fall. It can result in injury, produce discomfort and, for those with a history of falls, can result in several costly visits to the Emergency Department (ED) to make sure no serious damage has been done.
But can anything really be done for those prone to falls or with chronic conditions that may lead to repeated calls to 911 or ED visits for assistance? Thanks to a relatively new community paramedicine program at Adena Fayette Medical Center (AFMC), the answer is yes.
“Especially with our fall victims, we’ve done some pretty good work there,” said Tony Kegg, a 14-year paramedic who has been one of the driving forces behind the development of AFMC’s community paramedicine program. “We had a patient in 2019, she called EMS 37 times for falls. The following year, she only called EMS three times. All it took was getting her a lift chair and getting rid of the couch she was using because she was falling off the couch all the time.”
Another patient, he said, had more than 30 ED visits over a six-month period. With the help of the paramedicine program, that number was has been reduced to just 10 subsequent visits, both saving the patient a significant amount of money while at the same time lessening the patient burden on providers in the ED and, by extension, reducing wait times for other patients.
Community paramedicine is a growing trend in healthcare circles, particularly in more rural areas. The Fayette County effort started by researching the trend back in 2018.
“Community paramedicine has only been around formally in the U.S. since about 2012, so Dr. (Emily) Johnson had contacted my boss and said, ‘Do you think we can do this? Let’s start a timeline and look into it,’” said Kegg, who is Community Paramedic certified through the International Board of Specialty Certifications.
Kegg likens community paramedicine to the type of preventative work fire services do that goes beyond their emergency response — educating the community and conducting such things as fire inspections to aid in fire prevention, thus driving call numbers down. From a paramedicine standpoint, 911 calls and the number of ED visits by patients can be reduced by identifying those who have chronic conditions or who are at repeated risk of injury and taking proactive steps to minimize risks.
Patients come to the program through several avenues, whether being identified as someone who has made several ED visits for similar problems or having been referred by their healthcare providers, a social worker, 911 or EMS crew or some other source. The goal is to be proactive in helping the patient find ways to minimize risks that in the past resulted in calls to 911 or ED visits.
“We want to reduce those calls to 911 if we can,” Kegg said. “We try to prevent hospital re-admissions, and especially for those with chronic obstructive pulmonary disease (COPD) and congestive heart failure, we try to get out to the house within 24 to 48 hours of them being discharged from the hospital to make sure they have their medicines, make sure they have all services in place that they need such as transportation to follow up with their primary care doctor. We also monitor their chronic illness as well.”
Education is another key component, both in providing patients with necessary knowledge about medications and details of the treatment protocols worked out with their primary care physician, as well as through connecting them with other resources.
From August of 2019 through late May of this year, Kegg had reached 230 individual patients through 994 total patient contacts. Edwin Robinett, who was having difficulty with the medicated eye drops he needed following an eye procedure, was one of them.
“Tony came, he put eye drops in for me, sometimes twice a day,” Robinett said. “He helped me fill out papers and called different places for me. He was always here when he said he would be and he really took good care of me.”
A minimum of three home visits are required for patients to be part of the program, but the length of time a patient remains before “graduating” out of it is dependent on his or her individual needs, the care plan worked out with the patient’s physician and the time it takes to connect to other resources.
Creating a community paramedicine program is different from community to community. In Fayette County, it was driven by information gathered in conjunction with the county health department for its Community Health Needs Assessment.
It also requires a large pool of resources from which to pull, including such individuals as medical directors, primary care physicians, nurse practitioners and social workers, as well as community organizations such as Community Action and local food banks to make it work efficiently.
But the benefits – to the patient in terms of cost savings and convenience, to health systems in terms of easing demand on emergency services and to the community in terms of offering proactive care options – have made it worth the effort both locally and elsewhere.
“Community paramedics are popping up all over Ohio, so it’s really gaining a lot of traction as a new healthcare model,” Kegg said. “I think you’ll be seeing a lot more of community paramedicine as time goes on.”