ANAHEIM, Calif. — A home-bound heart patient called 911. His leg hurt where a catheter was inserted, but he didn’t complain of chest pains.
To paramedic Scott Fox, it was the kind of call that might have meant automatically rushing the man to a hospital emergency room. “There was no talking him out of it,” Fox recalls. But now he had another option.
He arrived at the man’s home with a nurse practitioner, Victoria Morrison, who calmed him down, checked him out and contacted his cardiologist to set up a next day appointment. “We saved the ER visit for a patient, which wouldn’t have done anything for him anyways,” Fox says.
This city is one of several around the country that are looking to provide better patient care and cut costs by having nurse practitioners ride alongside paramedics on non-urgent calls. When it comes to a twisted ankle or minor stomach pain, the two work together to find a solution that avoids a trip to the ER.
“As far as the paramedic goes, you want to get on scene as quick as you can and you want to get them loaded up into an ambulance as quick as you can,” says Fox, who is also a fire captain. “Now you take a step back and say, what can we do for that patient here in their house to benefit them to keep them out of the ER when they really don’t have to go?”
In Anaheim, home to Disneyland, the fire department receives 31,000 calls per year, of which 85% are for medical assistance, according to Fire Chief Randy Bruegman. Of those medical calls, 35% to 38% are deemed non-urgent and low in severity. They can typically include animal bites, headaches, abdominal pain — the kind of calls that can quickly clog emergency rooms.
Anaheim created the one-year pilot program this year, working in conjunction with a local ambulance company, Care Ambulance Service, medical provider Kaiser Permanente and an association of local fire agencies. The project is costing about $500,000.
Officials don’t yet have an estimate on expected savings, but they are tracking data throughout the program.
The pilot aims to help alleviate the stress of overcrowded waiting rooms, an issue that plagues Southern California, as well as other cities across the nation, says Todd Newton, regional chief of emergency medicine at Kaiser Permanente. He says programs like these could significantly improve emergency health care for patients.
“They don’t have to come in. They don’t have to wait. They are being treated in a comfortable setting. It opens up our beds for people who really need them,” Newton says. “Everybody wins.”
The program was modeled after a similar pilot being tested in Mesa, Ariz. The Mesa Fire Department, which began a pilot program several years ago, now runs three fully operational paramedic-nurse practitioner units around the clock through a multimillion-dollar grant awarded by the Centers for Medicare and Medicaid Services.
Mesa initially created these programs as a way to cut emergency room wait-times and save money for the department, but the programs have since morphed into a way to provide better care for patients.
“We’ve gotten great feedback. It’s just really good patient care and customer’s service,” says Deputy Chief Steve Ward, who manages the program. “We’re seeing a great saving to the system as a whole.”
The goal of these programs is always the same: to manage emergency responders and available ambulances more efficiently.
“There are days that we have lost ambulances for up to eight to 12 hours, that have been out of service and not available to answer that next 911 bell because they’ve been delivering a patient to an overcrowded ER,” Care Ambulance Director of Operations Bill Westin adds.
In Anaheim, Fox, who has worked as a paramedic for 20 years, says he and Morrison typically bring a more personal level of emergency care. For example, Morrison gets the patient in touch with his or her primary care doctor right after the call, a protocol not usually seen in an ER visit.
“The look that these people get on their faces is astonishment that we’re actually bringing someone like that into their home,” he says.
But Fox and Morrison say they always work with caution. Fox leads each call by assessing the situation for any signs of immediate, paramedic care. Once the patient has been cleared of emergency needs, Morrison steps in for diagnosis and treatment.
The program also provides a calmer environment for patient treatment. Morrison, who has been a nurse for the past 15 years, knows first-hand how scary an ER visit can be.
“When you going into nursing or medicine or any kind of health care, I think we all have this vision of going into people’s homes, like they used to, and treating them,” Morrison says. “We’re coming full circle. We’re coming back to treating patients in their homes again and it’s great.”