I need your hippa compliant case summaries

[DesertMedic66]

I don’t think having a bunch of strangers on an internet form saying “one time I had a patient with a cough call 911 and went to the ED but could have gone to an Urgent Care” will be extremely useful for you. Getting together with an EMS agency where you can review many patient charts and more in depth patient information will probably be much more useful.

 

[medic2EMSdoc]

I don’t think having a bunch of strangers on an internet form saying “one time I had a patient with a cough call 911 and went to the ED but could have gone to an Urgent Care” will be extremely useful for you. Getting together with an EMS agency where you can review many patient charts and more in depth patient information will probably be much more useful.

The later that you described is in definitely more useful and something that I am already doing but the thought was to get some additional examples from outside my direct area, which is what the internet is helpful for....but thanks for the feedback.

 

[Akulahawk]

I don’t think having a bunch of strangers on an internet form saying “one time I had a patient with a cough call 911 and went to the ED but could have gone to an Urgent Care” will be extremely useful for you. Getting together with an EMS agency where you can review many patient charts and more in depth patient information will probably be much more useful.

The later that you described is in definitely more useful and something that I am already doing but the thought was to get some additional examples from outside my direct area, which is what the internet is helpful for....but thanks for the feedback.

Given you're an ED physician, you should be able to obtain plenty of examples from your local area from your local providers and from your own cases you have treated that you feel could have been properly cared for by some alternate destination than your ED. Being that this is something coming down the pike from CMS, you can bet that there will be more than a few EMS agencies that will be implementing transport policies for this once CMS clearly begins paying for transport/care provided to patients that are transported to an alternate destination.

 

[medic2EMSdoc]

You guys have made it clear that you don't think this is a place for cases; sorry for bothering to ask. I was just looking for a place to start some "additional" discussions and obtain "additional" different perspectives. Because honestly some of the services I ran with got their protocols from a crackerjack box and didn't take some real world situations into consideration. Feel free to let this thread die or request for it to be deleted.

 

[DrParasite]

- Patient is treated on scene - That is care provided for FREE, cause Payers don't pay for that either

not necessarily; we billed ALS 1 rates for every diabetic we woke up, as well as for cardiac arrests, even if they weren't transported.

- Patient should be taken to a urgent care center or PCP's office - GREAT but again under current payer model - they don't pay for that.

fair point. the other side of the coin is many urgent cares are great for stable patients, but anyone remotely sick and they call 911 to send them to the ER. and your definition of remotely sick, my definition of remotely sick, and their provider's definition might be vastly different.

So Health Economics 101 - if medicare will reimburse for something usually other payers will follow suite.

Fair point. However medicare primarily covers the elderly, while many of the patients that should go elsewhere don't qualify (or don't have insurance).

I'd love to discuss the options you listed above Dr.Parasite what role do you play in EMS so I can know how best we can discuss them.

I've been in EMS since 1998, worked FT in various urban cities in NJ from 2005 to 2014, including 5 years in communications and special operations, and now I teach EMS courses and ride the BRT.

You guys have made it clear that you don't think this is a place for cases; sorry for bothering to ask.

That's not what happened at all. you asked a bunch of people to provide you with information without providing any background information for who you are, or what you planned to do with the information.

I was just looking for a place to start some "additional" discussions and obtain "additional" different perspectives.

We can give you "stories" but without all the details, you have no way to validate anything that is said. Which is why several people told you to go to the local EMS system.

Because honestly some of the services I ran with got their protocols from a crackerjack box and didn't take some real world situations into consideration.

Sure... which is why you need an involved medical director who has real world experience, coupled with accepting feedback from those boots on the ground personnel, to improve things.

Assuming you are an ER doc, and an EMS DOC, write up a proposal. Put your name on it, the sponsoring agencies, etc, and publish a draft. Than reach out to all the EMS PR places (magazines, websites, podcasts, social media, you name it) with a survey monkey link, or an email address, asking for stories, including contact info and agency info so you can review what is being told to you vs what actually happened. I know this might shock you, but there are people who walk into the ER's triage entrance that get admitted, and those that are brought in by an ALS ambulance who are discharged an hour later. And they you get the people who take the train to get to the city the hospital is located in, and then call 911, walk to the ambulance, walk to triage, and end up admitted due to abnormal labs.

Coming in asking for hipaa compliant summaries without any background information about you or agency that is supporting your project would not have been my first idea

 

[KingCountyMedic]

FDCARES | Puget Sound Regional Fire Authority

The Fire Department Community Assistance, Referrals and Education Services program, referred to as FD CARES, is a fire agency-based community injury and illness

pugetsoundfire.org

You could probably get some information from these fine folks. It's a great program we use for the non emergent, "frequent flyers" and so forth.

 

[Akulahawk]

You guys have made it clear that you don't think this is a place for cases; sorry for bothering to ask. I was just looking for a place to start some "additional" discussions and obtain "additional" different perspectives. Because honestly some of the services I ran with got their protocols from a crackerjack box and didn't take some real world situations into consideration. Feel free to let this thread die or request for it to be deleted.

I think you misunderstand what we're trying to tell you. What you don't need are case studies, you first need to see policies, procedures, and protocols from other systems that implement something similar to what you're looking for. The Local EMS Agency near me isn't quite ready to implement an alternative destination policy but I suspect theirs is coming within the next year or so.

 

[RocketMedic]

You guys have made it clear that you don't think this is a place for cases; sorry for bothering to ask. I was just looking for a place to start some "additional" discussions and obtain "additional" different perspectives. Because honestly some of the services I ran with got their protocols from a crackerjack box and didn't take some real world situations into consideration. Feel free to let this thread die or request for it to be deleted.

Doc, a lot of what we have is going to be a significant challenge because our current documentation is designed to emphasize why they should have gone to the hospital, even if the underlying complaint is really really really really minor, because that's how our current leadership and system want calls written.


I'd recommend you reach out to Houston Fire and ask about ETHAN, which is a diversionary alternative that has shown considerable promise. They are making contact with a provider on every ETHAN call and essentially extending telemedicine to the EMS field, allowing more-informed diversions than purely protocol-driven diversions; it also offers additional diagnostic abilities as compared to protocol-driven ones as well (since the telemed system can also be used to persuade people to go).

As far as case summaries go, pretty much any minor trauma comes to mind, along with almost all psychiatric complaints and a decent amount of the "misc" complaints like "I need my meds refilled" or "my feet hurt". The biggest challenge with those is that the people calling for help are typically not ones who can get care at most private or for-profit urgent cares or primary care offices and often face mobility issues that need a wheelchair van, car or ambulance to get them to their appointment in the first place; and have issues that keep them from filling the recommendations (money, identification, a stable home, food, etc). That means that most alternates are going to be charity, nonprofit or governmental.