How Parkview Health created an innovative community paramedicine program to combat sepsis
How did an eight-hospital, 887-bed health system serving 820,000 patients reduce unnecessary emergency room visits, increase early detection and treatment of sepsis and decrease the mortality rate of its patients—all while lowering its overall health care costs?
By taking the hospital to the patients rather than the patients to the hospital.
In October 2015, Fort Wayne-based Parkview Health received a two-year grant from the Indiana State Department of Health (ISDH) to launch a community paramedicine pilot program. In this innovative model, paramedics work outside their normal emergency response roles to provide preventive and follow-up care to people in their homes or skilled care facilities. Their goal: to help people regain optimal well-being outside the hospital setting.
The pilot phase of the program kicked off within Allen County long-term care facilities. According to Susan McAlister, D.N.P., RN, vice president of clinical integration, the primary focus was on sepsis due to the high number of sepsis cases in Parkview emergency rooms. Nurses and certified nursing assistants at these facilities were trained to identify, treat and monitor sepsis patients. This initial pilot led to a decrease in both readmissions and observed/expected mortality in sepsis patients.
To further enhance the program, Parkview partnered with six skilled nursing facilities and provided each partner with training on the recognition, treatment and prevention of sepsis. Paramedics were in the facilities providing care on behalf of Parkview by May 2016.
A PROGRAM FOUNDED ON COLLABORATION
“All six of our community partners go through the STOP AND WATCH screening process for sepsis,” said Chad Owen, director of communications, EMS, flight services, patient logistics and flow at Parkview. “If a resident is determined to be sepsis positive, the skilled nursing facility will activate our dispatch center and we’ll send our paramedics to them to draw blood, do a chemistry panel and run other tests on the patient.” This is not a 911 call but rather a call to an 800-rapid response line, which streamlines the process and ensures the paramedics arrive for timely treatment.
Parkview’s five paramedics trained for up to three months in a diverse range of hospital settings to prepare to provide care under the new model.
“We identified all those areas in the health care system that we might lean on during the sepsis treatment process,” Owen said. “When we started the orientation, we put the paramedics in the medical ICU where a lot of the septic patients land. They came to understand the whole process that these patients go through, from intubation to the long road to recovery, and they were able to see the end result of sepsis, which paramedics never see. It made our team appreciate the need for early identification and treatment.”
CARING FOR PATIENTS WHERE THEY LIVE
When the paramedics aren’t responding to sepsis cases in skilled nursing facilities, they’re tending to high-utilization patients in their own homes. Paramedics help patients with a record of frequent emergency department visits with everything from finding a primary care doctor to providing safety evaluations of their homes to ensuring that they can access their medications.
“The people our paramedics are touching are underinsured and uninsured. They’re people who have a total lack of resources, even from their own families,” said Owen. “We run across a lot of people who have no one to turn to.”
“The community paramedics were surprised by how many people saw a physician and then didn’t have resources to get the walker they needed,” said Brett Steffen, program manager with Parkview Samaritan Medical Transport. “It’s been a real eye opener to see how many people need that assistance. We’ve touched over 1,300 people already this year through our population health piece with just five folks.”
Steffen has enjoyed the depth of care he has been able to provide to patients in the community through the new program.
“As paramedics, we’re used to answering that 911 call and being with a patient for 20 or 30 minutes,” he said. “In this program, many times we’re with a patient for a week or two and we really get to dive deeper down into their needs and who they really are. It’s a lot different than working on the street.”
“Already we’re seeing wonderful outcomes from this piece of the program,” Owen said. “Our paramedics are identifying those patients with a high incidence of readmission very early and getting orders to manage them at home. And the patients love the program. They feel like they have support when they get home. Our paramedics have been thanked more doing this program than anything they’ve ever done in the 911 sector.”
HELPING FAMILIES MAKE THE RIGHT CHOICES FOR LOVED ONES
The program also has been successful in identifying those patients who would be better off avoiding the grueling sepsis treatment process and instead opting for palliative care.
“Sometimes it’s easier to not go down a road than it is to go down that road and try to come back,” Owen said. “Through this program, we’re able to have conversations about palliative care early on with the family members of patients who are too severe to begin treatment. It’s helped ease their minds to know they’re not going to put mom or dad through treatments that won’t be successful.”
Owen recalled the story of a severely septic patient and her two sons who were attempting to make the right decision about the care she should receive.
“They’d never navigated a medical journey like this before, and they were so appreciative of the foresight and compassion that our paramedics provided,” he said. “If it was just for that one patient, that would be a successful outcome, but we have had multiple stories like that in which our crews have helped families make difficult decisions and improve end-of-life care for patients.”
OUTCOMES AND ADVICE
Over the course of the last 18 months, Parkview Health’s community paramedicine program has achieved stunning results that go beyond the anecdotal and into the heart of what most population health programs aim to achieve. The outcomes include the following:
“We have a lot of hospitals who are interested in our program, and the one thing we always tell them is to identify the gaps of the health care need in your area,” Owen said. “By doing a gap analysis, you can learn what resources and needs are already available in your area. That way you don’t have to recreate the wheel and you decrease the risk of reproducing resources that already exist.”
“A lot of other service providers in the community could feel threatened by a program like this,” Steffen said. “It’s important to be collaborative and educate them about how you can complement each other.”
In the spirit of collaboration that defines population health, Owen is willing to share the fruits of Parkview’s labor.
“If there’s anybody out there who wants to learn more about our program, they’re more than welcome to come see for themselves,” Owen said. “We’ll share anything.”
STOP AND WATCH: SEPSIS DETECTION PROTOCOL
S eems different than usual
T alks or communicates less
O verall needs more help
P ain—new or worsening; participates less in activities
A te less
N o bowel movements in three days or diarrhea
D rank less
W eight change
A gitated or nervous more than usual
T ired, weak, confused or drowsy
C hange in skin color or condition
H elp with walking, transferring or toileting more than usual