A pilot program that teamed the Rockford Fire Department with SwedishAmerican Hospital to reduce the number of times “superusers” ride an ambulance to the emergency room was successful this year, b how to fund an expansion of the program remains unclear.
Eight of SwedishAmerican’s estimated 380 patients who use the emergency department more than 10 times per year and often visit dozens of times were chosen to participate. Nurses and fire personnel conducted health and safety check home visits during the first half of the year, significantly cutting the number of times the patients wound up in the ER, said Dr. Kathleen Kelly, the chief clinical integration officer for SwedishAmerican.
Called the Mobile Integrated Healthcare pilot program, it involved just a fraction of the number of patients who are using, and in some cases abusing, ambulance services in Rockford. The goal was to reduce the number of avoidable ER visits and ambulance rides while improving the health of the eight participants.
“After our intervention where our team made proactive home visits to our patients to try to understand what the triggers were for coming to the emergency department, they were able to reduce the (emergency department) and ambulance transfers by a significant amount,” Kelly said.
Officials said an expansion of the program, which could involve funding and cooperation from all three major health systems in the region, would be effective. And the results match what has been seen in other places across the country that have implemented mobile health care programs.
The eight patients chosen for the pilot program visited the SwedishAmerican Hospital emergency room a combined 65 times the first six months of 2014. With assistance from home visits, the number of their ER trips dropped to 30 in the same time period this year, a 54 percent reduction. In addition, they took 30 ambulance rides in the first half of 2015, a 38 percent reduction from the 48 rides they took in the first half of 2014.
All have complex medical conditions requiring treatment with medications. But much of the time, a visit to the primary care physician would be a better use of resources and provide improved health results, Kelly said.
They are often living in poverty or have low incomes and might not have access to resources or transportation. Just providing the patients with a phone number to reach nurses who could answer their questions prevented many calls to 911, Kelly said.
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Excerpts from RRStar.com:
Much the way social service agencies work to put themselves out of a job, fire departments do the same.
Although municipalities typically require builders to put smoke detectors in new homes, many fire departments provide free smoke detectors to residents of older homes and conduct free home inspections to identify possible fire hazards. Overhead sprinklers are required by code in new commercial buildings, especially high-rises. Even the number of wildfires caused by discarded cigarettes has declined by 90 percent according to the U.S. Forest Service Southern Research Station.
The end result is fewer fires nationwide. Rockford is no exception. There were 638 structure and non-structure fires in the city in 2014, down 20 percent from 796 in 2005.
Even though there are fewer fires, the Rockford Fire Department’s call volume continues to rise by an average of 3 percent each year. Of last year’s 26,010 calls, just 2.45 percent were for fires. A whopping 80 percent were EMS and search and rescue related.
Driving the increase in medical calls is an aging Baby Boomer population. Between Jan. 1 and Sept. 30 of 2014, 20 people accounted for 192 calls and visits to SwedishAmerican Hospital’s emergency room.
This year, the Fire Department in partnership with SwedishAmerican Hospital initiated a pilot program called Mobile Integrated Healthcare. A focus group of about 20 people known as “frequent fliers” were identified for making numerous 911 calls and ER visits by ambulance.
Bob Vertiz, Rockford Fire Department EMS coordinator, and two SwedishAmerican nurses with case management and social service work training, routinely visited the would-be patients at their homes. While Vertiz checked for fire and safety hazards in the home, the nurses made sure the patients were taking their medicines as prescribed and scheduling their doctor visits. They also tried to address any other heath concerns expressed by the patient.
“Most of the people who utilize our services often have legitimate health concerns,” Knott said. “The ideal of a mobile integrated health care program is to get those people in touch with the right services. Picking someone up at their house and taking them to the hospital isn’t the care that they need. They need long-term solutions to issues, and that’s what this does.”
The results of the pilot program are expected to be released at the November Rock Stat meeting.
To expand the program and devote more firefighters and nurses to the program would likely be an expense in the short-term. However, if you consider the costs involved each time an ambulance and fire truck responds to a medical call, the program has the potential to produce huge savings to the patient and the city in the long run.
“It’s not just about dollars for us,” Knott said. “We look at the care of patients. That’s really where our concerns are.”
Heather Schafer, National Volunteer Fire Council chief executive officer, said the volunteer fire departments are experiencing the same trend of fewer fires and responding to an 80 percent EMS call load. In many cases, they are doing so with fewer resources than full-time fire departments.
“A lot of departments are asking their firefighters to be crossed trained, and funding is definitely a challenge,” she said. “When you look at the training, the equipment and the cost of the apparatus involved, that’s a lot of chicken dinners.”
Cherry Valley Fire Protection District Chief Craig Wilt said his department has 15 full-time firefighters and 30 paid-on-call firefighters. He said the EMS calls account for 75 percent to 80 percent of the department’s call volume.
“As the Baby Boomer population continues to age the number of EMS calls will only go up.”
While OSF Saint Anthony Medical Center provides free paramedic training, Wilt said certification can be a two-year process, which means when firefighters are in training, other firefighters are paid overtime to maintain an adequate staffing level.
One way to cut down on that expense, Wilt said, “All new full-time hires have to already be a paramedic at the time of hire.”
