September 11—Ohio passed legislation that expanded care beyond 911 calls, allowing community paramedics to be among the ﬁrst responders who could visit patients in their homes to provide care outside of 911 calls. This enabled community paramedics to become part of a care team, alongside a patient’s physician or case manager.
The Upper Arlington Fire Division’s Community Assistance, Referrals and Education Services (CARES) started in 2017 in Upper Arlington, Ohio. UA CARES consists of a team of ﬁreﬁghter-paramedics, a program manager, and an EMS and Training Captain. As repeat 911 calls for falls continue to increase around the nation, UA CARES focuses on improvements to better identify residents at-risk for falls and provide necessary home modiﬁcations and resources. UA CARES works to go beyond standard emergency medical services delivery by focusing on prevention: making patients safe in their homes and reducing expensive emergency room visits and re-hospitalizations.
A number of these patients—who stood to beneﬁt under Ohio’s expanded legislation—were elderly individuals at risk of falling in their homes or had a history of falls. Others had a medical history of chronic conditions, mental illness, and/or substance abuse. Tracking their care and communicating with everyone on the care team, including those within Upper Arlington Fire Division, hospitals, social workers, and police, were critical to generating a real impact.
However, as the UA CARES program grew, intake processes and ﬁle management were still too cumbersome. “We used to start out with clipboard and about 30 pieces of paper,” said Mindy Gabriel, a ﬁreﬁghter and paramedic with Upper Arlington CARES. “Intakes could take one to two hours depending on how much the patient wanted to tell us or what the situation was inside the home. Then we manually scanned all this paperwork or had to email several people on a care team to keep everyone updated on how a patient was doing”.
At the beginning of 2019, the Upper Arlington CARES program went digital. HealthCall worked with paramedics to conﬁgure and customize their own care plans, assessments, and outreach around their administrative and clinical processes. Once a patient is entered into the CARES program and is deemed a “falls risk,” HealthCall enables a process of management-by-exception, allowing paramedics to have best practices on-hand, have patient’s vital information and medical history quickly available in real-time, and know who to call to ensure more timely and targeted care. “HealthCall is a game-changer that allows us to prevent more and react less,” said Mindy.
HealthCall has not only helped reduce time spent on documentation, it has also helped increase the number of referrals medics make directly to UA CARES. When selecting interventions on the ePCR, or electronic Patient Care Report, medics can immediately notify UA CARES when a patient follow up is needed. “HealthCall was integral in connecting two systems to work together,” said Lieutenant Mark Weade. “The improved work ﬂow allows more time to be spent directly with patients.” Preliminary data shows the Upper Arlington CARES program has experienced a 5% decrease in fall related calls and a 41% decrease in fall related transports. The numbers reﬂect a broader timeframe prior to HealthCall implementation, but represents a positive outcome in the eﬀorts toward fall-prevention.
Bi-directional communication is important to the UA CARES team and it is vital when trying to be an agent of change in patient care. Most often, patients are the ones that need to self-report to their care team when they’ve had a fall or 911 call. A high percentage of 911 calls and falls go unreported. HealthCall can change that paradigm. UA CARES ﬁreﬁghter and paramedic, David Wisner, says “HealthCall is a system that will allow us to provide critical information to ﬁrst-responders and incorporate the patient’s healthcare team for further follow up and collaboration.”
Home safety for patients is a major factor. Thanks to HealthCall, ﬁreﬁghter/paramedics now have centralized, immediate, actionable data on-hand, such as which bedroom to go to in order to assist a child who wears cochlear implants and can’t hear a ﬁre alarm. Or when they are visiting a patient at risk for a fall, does this patient have working smoke and carbon monoxide detectors, do these detectors need new batteries, or could these detectors be better placed in the home? Or does the patient need grab bars installed to reduce the risk of a fall?
“HealthCall has exceeded our expectation and improved our program all-around,” said Upper Arlington CARES Program Manager and Service Coordinator Christine Leyshon. “Streamlining care leads to better care coordination which leads to improved patient safety which leads to the likelihood of keeping patients safe in their homes and out of the hospital.”
Fellow ﬁreﬁghter and paramedic Jason Cable adds that HealthCall’s software capabilities has added a layer of accountability to ﬁrst responders. “Everything is linked up, as we become responsible for this patient data we’re generating from these visits, how the information is shared and how the information needs to move. We’re not creating a bunch of phone calls or emails anymore where things might fall through the cracks. And the silos are gone. We get to oﬀer more comprehensive care.”
The UA CARES team agrees, “as we expand our program and set goals, HealthCall is there for us every step of the way. They truly care about service delivery and the impact on patients. HealthCall also goes beyond customer service and links their clients with other innovative programs across the country.”