Community paramedics are the cornerstone of REMSA’s Community Paramedicine program. This group of specially-trained paramedics evaluates patients and performs tasks under approved protocols. Patients have access to care by community paramedics after referral from a primary care physician or other referring healthcare provider. All community paramedicine services are performed within the existing clinical scope of practice of a Nevada licensed paramedic in an expanded role. There are three types of service:
- Post-hospital Discharge Patient Follow-up – In-home visits and/or follow-up calls assist patients in avoiding hospital readmission after they have been discharged from the hospital. This is accomplished by promoting physician treatment plan adherence by providing information, education and guidance while monitoring patients in their home. Patients are enrolled and monitored for up to 30-days after discharge.
- Episodic Evaluation Visit – In-home visits within four (4) hours of a request provides primary care physicians or referring healthcare providers with an in-home patient care service when there are limited resources available and an emergency department visit may not be optimal.
- Hotspotter Intervention – Following identification and assessment of patients that make frequent visits to the emergency department or frequent calls to 9-1-1, this intervention assists patients in accessing the right care or service and includes a resource plan to resolve each patient’s unmet healthcare, mental health and social service needs.
In cooperation with the community’s health care partners, this program will safely:
- Improve each patient’s satisfaction with their overall health care experience
- Improve referring provider’s knowledge of the patient’s home environment, including medication usage, health routines and living habits
- Improve referring provider’s access to accurate and timely early warning signs of worsening conditions
- Avoid exacerbations of chronic illness through close observation and early reporting of symptoms
- Avoid an unplanned hospital readmission and avoid unnecessary utilization of emergency services (such as a call to 9-1-1 or a visit to the emergency department)
The Community Paramedicine program features in-home visits to patients with feedback to referring provider. REMSA’s program is unique in the following ways:
- REMSA has developed specialized protocols including: congestive heart failure, COPD, post-myocardial infarction, and post-cardiac surgery, among others.
- During in-home visits, community paramedics reinforce healthcare provider discharge instructions and treatment plans, provide education specific to each patient’s health literacy level, provide medication reconciliation and reminders of follow-up appointments.
- In-home care includes protocol-driven, in-home medical procedures, including, but not limited to, IV diuresis and hydration with follow up lab work, nebulizer with medication delivery and 12-lead EKG with interpretation and transmission.
- Point of care lab work (including BMP, H&H, blood glucose, blood alcohol, clean catch UA, and INR) and home blood draws are delivered to local labs with results made available to the patient’s care team for timely follow-up.
- Services include monitoring and trending of vital signs, weight and medications; timely communication of abnormal findings to the referring provider; and identification and documentation of recommended versus actual medication usage.
- Patients initial visit includes assessment of in-home environment and identification of need for and referral to in-home support services, community resources and assistance with coordination of follow-up appointments as needed.
- Patients are provided with a direct phone number in order to access community paramedics 24/7 for questions or concerns during the enrollment period.
- REMSA’s medical director oversees a rigorous clinical quality assurance program that includes specialized training, regular chart audits and ongoing clinical reviews.