Please elaborate in great detail. I am not above admitting I am wrong but the requirements are high when you are trying to convince me that an emergency-trained provider can offer equivalent services to an RN.
We are not providing equivalent services to an RN. Your words were "exclusive domain," and that is the untrue part. Our program does not seek to replace home health care, but rather help fill the limitations of home health care in our region.
Currently our biggest aspect is responding to mental health calls. The governor established Colorado Crisis Services, and our local Medicaid contractor provides mental health crisis response, to include mobile response and freestanding "psych ERs." They in turn subcontract to us to provide mobile response to our district, as we are rural there is very little in the way of existing mental health infrastructure. Our paramedics respond to crisis hotline activations, 911 calls for non-violent behavioral disturbances, and law enforcement requests. The paramedic responds alone in an SUV and along with the patient and their medical health professional (if one exists), determines a plan. Often times this is transport to the Crisis Stabilization Unit (pysch ER). A checklist was developed jointly between the CSU and our staff. This includes a significant medical assessment in which patient's receive a typical EMS assessment, BAC, saliva drug screen, and lab draw utilizing a CSU provided iStat. Provided the patient meets assessment criteria and are voluntary, they are transported by the single paramedic to the CSU or inpatient psych unit. Sometimes, in consultation with their own therapist, we are able to leave patients at home. And of course sometimes patients are still transported by ambulance to the ED, though are numbers of psych transports by ambulance have been reduced by over half. Patients are charged a base fee in the 100-140 dollar range plus mileage, which certainly beats an ambulance bill.
At no point was the VNA (which we don't even have here) or any other nursing entity providing or attempting to provide similar service. There was nothing but EMS transporting to the ED. Our paramedics received a week long mental health assessment program from one of our paramedics who is also a psychologist. They also receive a motivational interviewing program and spend 24 hours of clinical time at various psych facilities. Certainly this is not a tremendous amount of education. But look closely at what are people doing: resource navigation. There is no need for us to take the role of psych professional. Our goal is to be able to get patients the proper destination beyond the ED if possible. We developed a program and are making a significant cost savings for the patient, service, and system.
Our program also seeks to identify patients who burden the 911 system. Between the paramedics and medical director, patient specific care plans are developed to deal with chronically ill patients who use the 911 system to manage their chronic illness. In addition to communication and community resource education, our paramedics receive additional pharm education, fall prevention strategies, and workshops on various chronic conditions (CHF, DM, etc). But again, most of the job is centered around resource navigation. We set patients up with home health and/or hospice. We'll find them a doctor, a clinic for their disease, or even a skilled nursing facility. We'll talk to their physician and/or home health to come up with a plan that usually does not involve a transport to the ED. Most of our over-users can be divided by those that do not follow their discharge instructions and those that have no idea what resources are available. By partnering with other healthcare interests we can be the "boots in the house" that actually sit down with the patient and work on a plan.
And our local home health nurses love us. They have very limited staffing, and we can argument that, especially at night. Our people are not the ones writing the plans for these patients, and we do not intend to. We just want to help the patients stick to their care plans and keep them out of the hospital. Of note, we also work with hospice for after hours response. We're able to provide pain management until their staff arrives and determine if the patient should/needs to be transported to an ED for treatment that is not related to their "hospice condition."
Eventually we hope to directly partner with hospital networks to assist in their readmission prevention programs, though this will require more education and a willingness from the hospital to try something new. Currently neither of the hospital networks have any sort of local presence to provide in-home follow up care, so it would seem they have little to lose.
The one thing I cannot stress about our program is that we are primarily there to assist patients in navigating the healthcare system. The extra education helps ensure that we determine patients are properly eligible for certain resources, and to think that this is only a job for nurses makes little sense to us, especially considering their exceptionally limited local resources.
I hope I have
elaborated in great detail for you.
I will happily post the program syllabus for you when/if I receive one from the community college whose website is just terrible. ETA: The program is about four months long when done on duty.
