Presentation - Canadian Foundation for Healthcare Improvement

Community Paramedicine and the
Extended Care Paramedic
Enhancing Primary Health Care:
Through Innovation at the
Community Level
Tom Dobson ACP BA MPH(c)
Ken Buchholz MD CCFP FCFP
EHS Emergency Health Services Nova Scotia
Income &
Social
Status
Culture
Social
Support
Networks
Gender
Education
Health
Services
Community
Health Advisory
Committees and
Boards
Employment/
Working
Conditions
Social
Environments
Physical
Environment
Personal
Health
Practice &
Coping Skills
Biology &
Genetic
Environment
Healthy Child
Development
Present Model of Primary Health Care
Disconnect
Other Providers of
Primary Health
Care
GP/FP
Specialists
Leveraging our Resources
Convergence of Models of Care
Community Paramedicine
Project
Acute Care Response Model
Emergent/urgent care
Basic assessment skills
Limited management skill set
Transfer capability
Communication network
Surplus capacity
Provide elective care
Merge skill sets
Community Paramedicine
Semi-urgent/elective care
Value-added
Enhanced assessment skills
Efficiency
Enhanced management skills
+
+/- Transfer capability
Communication network
Efficient use of staff
Physician
Nurse
Community Care
Paramedic
Paramedic
Provincial Registration Card
Community Paramedicine
Long and Brier Island Project
Two small islands off
the north west coast of
Nova Scotia.
Population Approx.
1200 of which >50%
are over age 65.
1 – 1.5 hrs to nearest Family Doctor or Emergency Department.
Many residents have no means of transportation.
• One ambulance stationed at the local clinic 24/7.
• Staffed with two Paramedics.
• Duty Paramedics responded to all local
emergency and non-emergency calls.
• Low volume of calls on the Islands. Approximately
150 annually. (approx. 1 call every 2.8 days)
• This low volume provided opportunity for
additional services to be provided to the citizens of
the Islands
• And the Expanded Scope Program was born
A Novel “Healthcare Extender”
“the right provider for the situation”
Community Paramedicine
V.I.S.I.T. Program
Vital signs
Interview
Safety Inspection
Treatment
–
–
–
–
–
–
Home visitation (V.I.S.I.T.)
Assisted “self-care”
CDM and follow-up
Enable earlier discharge to home
Triage, treat and release
Extended care paramedicine program
 Well woman clinics
 Well baby clinics
 Healthy Islander clinics
 Smoking cessation
 Exercise classes
 Venipuncture Labs
 Vial of Life
 Flu Clinics
 V.I.S.I.T. program
Partnering with the Nurse Practitioner
And Collaborating Physician
Health Service Utilization
July 2001 – April 2006
• Average visits to emergency departments
per month in NS by Long and Brier residents
decreased by 40%
• Average FP visits per month in Annapolis &
Digby Counties by Long and Brier residents
decreased 24-28%
Call Response Intervals for L & B Islands
100
90
80
70
60
50
40
30
20
10
0
<9 min
< 15 min
< 30 min
> 30 min
2000
2004
2005
2006
• NP+Paramedic+Collaborating Physician
model improves access to care in rural
communities.
• NP+Paramedic+Collaborating Physician
model offers more comprehensive Primary
Health Care services than Paramedic-only,
NP-only or Physician-only models.
• NP+Paramedic model may be more sustainable
in rural community than models that use NP’s
only.
• Recognize the need to re-visit and re-align
goals and directions of the program
• Community leadership essential to plan &
implement change to model of health care.
Change Management
A partnership of the Department of Health, District Health Authorities and the IWK Health Centre.
--- Partnering Together --Change Takes Time and a Commitment for Support
Communities
EHS
DHAs
Continuing
Care
In partnership for excellence.
Collaboration
The Current Reality
Regional Hospitals in Nova Scotia - OLI ED
1:55:12
90 min
1:40:48
90th Percentile OLI
1:26:24
1:12:00
0:57:36
0:43:12
20 min
0:28:48
0:14:24
0:00:00
2002-2003
2003-2004
2004-2005
2005-2006
2006-2007
2007-2008
Facility 3
0:18:24
0:18:20
0:18:26
0:18:30
0:18:42
0:24:36
Facility 6
0:18:21
0:18:19
0:18:35
0:18:26
0:18:28
0:18:58
Facility 10
0:18:23
0:17:53
0:16:46
0:17:18
0:18:49
0:21:02
Facility 11
0:18:33
0:18:30
0:19:06
0:18:41
0:19:33
0:25:04
Facility 15
0:15:08
0:14:10
0:14:26
0:15:01
0:15:44
0:17:07
Facility 18
0:19:06
0:18:39
0:19:34
0:18:49
0:18:33
0:19:12
Facility 21
0:18:07
0:15:54
0:17:56
0:17:22
0:17:22
0:19:50
Facility 25
0:19:38
0:19:05
0:19:20
0:18:59
0:21:17
0:24:12
Facility 37
0:21:11
0:28:33
0:41:18
0:53:36
1:04:06
1:29:52
Facility 42
0:23:09
0:29:39
0:38:14
0:48:32
1:01:37
1:37:42
Facility 48
0:17:22
0:17:41
0:20:17
0:22:36
0:23:13
0:35:05
Time (years)
The Future of Community Paramedicine
--- Beyond Rural and Remote Communities ---
Extended Care Paramedicine Overview
Briefing & Report
to Oncoming Crew
Patient Treated
Not Transported
Or
Delayed Transport
Preload
Pump
COMMUNITY
PARAMEDICINE
COMMUNITY
PARAMEDICINE
Afterload
THINK OUTSIDE THE BOX!
????Questions ????
?
ARE WE THERE YET?