Promoting Innovation in EMS

WAKE COUNTY EMS: ALTERNATIVE DESTINATIONS FOR MENTAL HEALTH PATIENTS The Wake County EMS Alternative Destination program is designed for patients who suffer from substance abuse or mental health issues. Upon receiving dispatch of a psychiatric or drug related emergency an Advanced Practice Paramedic (APP) is dispatched along with a regular paramedic unit. Once on scene they go through a screening evaluation algorithm to assess if they can be transported somewhere other than the emergency department. The algorithm includes assessing whether the patient is combative, agitated or requires sedation. If the patient meets pre-determined screening criteria, the APP calls one of four potential facilities and discusses whether the patient is a candidate for transport to their facility. If the facility accepts, transportation is arranged by the APP, which provide report upon arrival. This avoids unnecessary utilization of ED resources and properly directs patients to a more appropriate facility.

interdisciplinary chapter at length, there is a strong economic argument for collaboration. There are often positive or negative externalities that affect other entities that are NOT currently bearing the expense or in control of a process. For example, while EMS might find it prudent and reimbursable to transport a patient in hospice to the ED when a caregiver becomes anxious when the end of life is near, the hospice agency experiences a significant cost associated with that transport in the form of lost revenue and poor quality metrics and patient satisfaction. This negative externality on hospice and palliative care is occurring in most communities. However, as is quite often the case with opportunities related to EMS innovation, this adverse effect that EMS is having on the hospice agency can be turned into a positive one. If EMS takes on additional costs in the form of additional training and medical oversight, and potentially longer scene times to coordinate care with the hospice agency, and lost revenue due to not being able to bill for transport, they can keep that patient in the home which positively impacts the finances and quality metrics of the hospice agency. By agreeing to share some of that positive impact with the EMS agency that bears the expense, both parties can benefit. Another example might be a new EMS initiative that navigates a patient to mental health services, thereby accruing benefits to patients via quality, EDs via decreased crowding, the criminal justice system via decreased recidivism, and to society via increased workplace productivity. From the state/ taxpayer perspective, they should support such an initiative because it would lower societal costs overall. Thus, the goal of community level engagement is to allow various societal stakeholders including nonprofits, criminal justice, government agencies, alternative-destinations

directly contract with EMS for such a system, but EMS could bring added value to the care of patients in such programs. Therefore, the hospital or physician group could be convinced to compensate EMS with funds from its bundled payment for care that is not tied to transportation to an emergency department. COMMUNITY STAKEHOLDER ENGAGEMENT Within each community, there are likely numerous opportunities for EMS to bring value to other stakeholders. Although discussed in the




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