By Melinda Young
An Ohio hospital teamed up with a local fire department to bring case management services to people at high risk of returning to the ED or hospital.
• The program targets people who call 911 when they do not need to be taken to the ED.
• The collaboration cut 30-day ED visits by 44%, and 30-day hospital readmissions by 28%.
• Firefighter paramedics visit people in their homes, helping them with fall risk assessment and checking on their health status.
An Ohio hospital’s population included people with lower income, less education, and many health challenges. Case management could help once these people entered the hospital, but the challenge was to prevent the problems that first led to ED visits and rehospitalizations.
“We felt we needed to engage community partners to help us improve our quality outcomes,” says Joe Geskey, DO, MBA, MS-PopH, vice president of medical affairs at OhioHealth Doctors Hospital in Columbus.
Geskey heard about a possible solution: EMS and fire department in one of the hospital’s areas already were performing community outreach.
A recent study of the hospital-EMS case management program demonstrated success. Patients in the program experienced a 44% drop in 30-day ED visits and a 28.4% decline in 30-day readmissions. The program also was cost-effective for the hospital, providing a $3,626 profit, compared with a loss of $9,915 for a control group.1
“I had the opportunity to meet the Norwich Township EMS provider, which had this very engaging model of being invested in the community and doing home visits for local citizens,” Geskey explains. “We decided to collaborate with our case management department here at Doctors Hospital and use some of the data we had already collected in our electronic medical record [EMR].”
The Norwich Township Fire Department in Hilliard, OH, had been providing paramedical services to its population for about four years. The program is called Focus Hilliard, and it includes a contract social worker, says Battalion Chief Chris Grile.
“Until we started this collaboration with Doctors Hospital, the way we started was through self-referrals from emergency calls,” Grile says. “Someone would call 911, and one of our staff would identify needs that were not necessarily correct for the emergency room, and identify other needs that needed to be met.”
Doctors Hospital’s plan was to create a list of inpatients who resided in Norwich Township, and approach them about the EMS service.
“We created a brochure and had case managers visit the patient and say, ‘You’re eligible for a service for EMS to see you at the hospital to make sure that you stay safe and well before you see your primary care physician,’” Geskey says.
A small group of firefighter paramedics visit people to assist with their needs. It might be to assess their home for fall risks, check on their access to medication or medication storage, or to sit and talk with people who are older and homebound and need someone to check on them, regularly, Grile says.
The Focus Hilliard program does not overlap with emergency services. If a person needs emergency medical care, the patient is transported to the hospital, he adds.
Here is how to create a hospital-EMS case management collaboration:
• Make a case for paramedicine. The study of the Norwich Township paramedicine program showed that hospitals benefit both financially and in quality outcomes from a collaboration with local EMS. However, there is a net cost to EMS: The study found that the intervention cost to EMS was $1,937. Hospitals could make these collaborations feasible through providing grants to fire departments to help offset the EMS costs.
A chief benefit to partnering with EMS is that it helps these community first responders continue to help their populations, even as the rate of fires and 911 emergencies drop. “This program gives us the ability to reduce risk in our community,” Grile notes. “The program gives us access to people we might only interact with through 911 calls of service.”
It has opened a new avenue of community engagement: “The more folks we can bring to Focus Hilliard, the greater number of people we can keep healthy and safe at home,” Grile says.
• Identify candidates for program. Doctors Hospital used risk modeling, based in EMR data, to gauge severity of illness and to assess how likely patients were to return to the ED or be readmitted to the hospital, Geskey says. “We tried to tailor interventions for people who had a high risk of coming back into the hospital unexpectedly,” he adds.
• Make referrals. Hospital case managers connected with the Focus Hilliard social worker to make referrals from the hospital’s list of eligible patients.
“Case managers go through the list and call Norwich,” Geskey says. “We give patients a brochure about the service.” Doctors Hospital also recruited patients to participate in a study of the hospital-EMS case management project.
• Find the right paramedics. “In my opinion, firefighter paramedics are the right people to do this work,” Grile says. “We have the respect and trust of the community and local jurisdictions.”
Firefighter paramedics are every community’s go-to people in the event of emergencies. “Whether a house is on fire or the basement is flooding, when you call 911, you get the fire department,” he explains. “Over generations, these are the people who come to your house when you need help.”
Firefighter paramedics form relationships with communities through this type of program, says Heith Good, firefighter paramedic for Norwich Township Fire Department. “We do our job in a far different way than taking someone who calls 911 to the hospital,” Good says. “We are problem-solving for people and taking care of their needs in a more intentional, relational way.”
They develop relationships and build trust with patients. “That was the excitement for us — walking away at the end of the day and saying we truly made a difference in their lives,” Good says.
“We solved a problem and met a need,” he adds. “At the end of the day for a firefighter paramedic, there’s a lot of value for that.”
- Geskey JM, Grile C, Jennings N, et al. Use of postdischarge emergency medical services to reduce hospital readmissions: Does it work and is it economically feasible? Popul Health Manag 2019; Oct 7. doi: 10.1089/pop.2019.0125. [Epub ahead of print].