A lot of emphasis has been placed on the role that telehealth plays for EMS in the overall continuum of care – how a patient’s experience can be virtually communicated and tracked from their home through their discharge – but that’s not the only area where emphasis should be placed.
EMS exists in an environment where anywhere from 10-50% of our patients don’t seek ambulance transport to a hospital. That means that their continuum of care starts and stops at the scene.
Following are 3 examples of where and how telehealth can benefit the treatment in place continuum of care.
1. Call follow-up
It’s 2:00 a.m. and your crew responds non-emergently to assist Mr. Jones who needs assistance getting off of the bathroom floor (lift assist). His wife was unable to assist him after he tripped and fell, so she hesitantly called 911, as her husband has had prior knee replacements and does not want to go to the hospital. He just wants help getting back into bed for the night.
You arrive and assess him, and then assist him back to a standing position, where he’s able to limp back to his bed with some stabilization support. He has no additional complaints and appears to only be experiencing some acute discomfort from his fall, so you complete your patient release/refusal documentation, explain your findings and have him sign your report. Before departing, you offer him a new service of your agency: a telehealth follow-up with your oncoming crew in the morning.
Your agency doesn’t have a community paramedicine program, but you do have a recently implemented fall follow-up program as a component of your agency’s community risk reduction initiative. In this follow-up, next-day crews will offer to virtually meet with fall patients and check in to see if they’ve returned to their normal mobility state. You also offer to conduct a later in-home visit to identify and review associated fall risks/trip hazards, make sure they have a functioning smoke/CO detector, and see that they have updated medication lists available. Mr. Jones agrees to this, and you’ve now created a happy “customer.”
2. Call check-in
After providing care for your acutely hypoglycemic patient in her home, your crew is comfortable with following your treat/release protocol which allows the patient to stay in their residence, but you find one sticky point that leaves you a little uneasy: the patient has a neighbor that can stick around by her side for about 30 minutes, but she will be alone afterwards. The patient agrees to eat some more food and re-check her blood sugar before the neighbor departs, and she also agrees to participate in a new check-in program that your agency has implemented, where medical-related release/refusal patients can receive a complimentary crew check-in a couple of hours after their departure.
During this check-in, the same crew will perform a brief tele-visit with the patient to heighten their confidence that the once-hypoglycemic patient has remained on a positive track without a hypoglycemic rebound. During this call, you notice her speech is normal, she’s able to answer some pertinent questions, and she even shows you the glass of juice and crumbs of the sandwich that she just got done consuming. Your comfort level in this patient release/refusal is now much higher knowing that you had an opportunity to check-in with the patient right after the call (not a day or more later).
3. Case referral
Your crew responds to a residence for an infant patient that has just had a seizure. Upon your arrival, you find a fully alert/active – although tired – non-seizing pediatric patient in the arms of his parents. His parents mention that the patient has had a fever and has been congested all of today, and experienced what appeared to be a brief, tonic-clonic seizure. You suspect this was a febrile seizure given this description and offer to call the emergency phone number for the patient’s pediatrician to discuss this case with the on-call nurse.
In doing so, you mention to the nurse that you have the ability to perform a live tele-visit, and the nurse offers to connect you directly with the on-call pediatrician via your telehealth platform’s link – which your crew sent directly to her. Within a few moments, you’re connecting with the on-call pediatrician to discuss this call directly. After which, all parties are comfortable with not seeking further hospital evaluation and the patient is scheduled for a follow-up clinic visit in the morning.
New-age community risk reduction
None of these situations involve the direct need for a fully-integrated, continuum-focused community paramedicine program. Telehealth makes these options possible for your on-duty crews (and the next days’ crews, too).
Each of these opportunities for telehealth visits/consults serve as components of your agency’s community risk reduction initiatives, which focus on patient outreach, wellness and navigation – and require minimal additional effort to conduct.
Combined with plans developed to address follow-up and check-in processes, online consultation or referral, patient access and security, incorporating telehealth visits into your agency’s repertoire of release/refusal situations can help to reduce patient recidivism, reduce patient expenses and increase patient satisfaction (immediately and after-the-fact) as it relates directly to your agency and its on-duty crews.
