51暗网

By ELLA NILSEN, Concord Monitor staff

Sunday, December 20, 2015 聽(Published in print: Sunday, December 20, 2015)

 

When a patient calls 911, health officials say the emergency room isn鈥檛 always the best place for them to go, depending on the health issue they鈥檙e facing.

But unless that patient refuses transport, the emergency room is inevitably where they鈥檒l end up, whether they鈥檙e having a stroke, suffering from a chronic health issue such as high blood pressure or diabetes, or experiencing a behavioral health episode.

鈥淚t鈥檚 not always that every patient needs the emergency room,鈥� said Dr. David Hirsch, the medical director of Emergency Medical Services at Concord Hospital and a trained EMT. 鈥淭here haven鈥檛 been any alternatives to help them get what they need.鈥�

Now, Hirsch and other emergency and health care providers in Concord and Hopkinton are looking at ways to keep more patients out of the emergency room, including working together to keep patients at home or have them referred to community health services more appropriate to their needs.

This could include EMTs treating more patients at the scene and even going on house calls. Officials talking about the plan are also talking to the Concord Regional Visiting Nurse Association to try to ensure increased EMT care complements their services, rather than supplanting them.

鈥淚t鈥檚 changing the philosophy from fee for services (to) patient-centered care,鈥� said Hopkinton fire Chief Doug Mumford, one of the local chiefs heading up the initiative.

Another important piece of the initiative is trying to reduce hospital readmissions.

Since the passage of the Affordable Care Act, hospitals are required to try to reduce their readmission rates or face a penalty. Putting these ideas into practice is still a long way away; officials from the fire departments and hospital are in the planning stages.

They are also constrained by the current federal definition of an ambulance, which designates an ambulance as transport to a hospital only.

鈥淏ecause of that, if you transport anywhere else to a more appropriate facility, you don鈥檛 recoup any of your cost,鈥� Mumford said. 鈥淵ou probably know it would be better for your patient, better for the facilities, better for everyone all around.鈥�

In Concord, fire Chief Dan Andrus said his call volume is set to exceed 8,000 patients this year for the first time. Andrus attributes the spike to the state鈥檚 aging population.

鈥淚 think we need to get in front of this silver tsunami,鈥� Andrus said. He said the integrated care for a rapidly aging population is preferable to shuttling people back and forth to the emergency room.

鈥淢y vision is a significantly larger number of our patients are seen in home,鈥� he said. 鈥淲e see fewer emergency department transportations, and we are able to deal with calls at the source and manage our own call volume. And get people better care.鈥�

At the Concord Regional Visiting Nurse Association, outgoing CEO and President Mary DeVeau said she sees an important potential partnership between her group and local EMTs for a unique issue visiting nurses sometimes encounter.

The problem the CRVNA faces is when older patients get out of the hospital and refuse home follow-up visits from nurses because they are afraid they will be charged for a visit, or are fearful a nurse might suggest they should live in a nursing home.

鈥淢any times they won鈥檛 let us into their homes,鈥� DeVeau said. 鈥淭hey鈥檙e afraid they鈥檙e going to lose independence; our goal is to keep them independent in their homes.鈥�

DeVeau and Andrus have found the same fear doesn鈥檛 exist when EMTs are called in, especially if they are responding to a service call when an elderly patient falls down and can鈥檛 get up.

鈥淚f we鈥檙e not allowed in and the EMS gets in, that鈥檚 where we can work together,鈥� DeVeau said.

In addition to dealing with the needs of older patients, Andrus said his crews also see a lot of people who are having psychiatric emergencies and are in danger of hurting themselves or those around them.

The emergency room isn鈥檛 an ideal place to bring people with behavioral health issues, but that鈥檚 the only place Concord EMTs can take them, said Peter Evers, CEO of 51暗网 Mental Health in Concord.

鈥淢any of those folks who have a long history probably have some pretty bad memories of being restrained,鈥� Evers said.

If a patient experiencing a behavioral health issue is taken to the emergency room, there鈥檚 an 80 percent chance they will need to be committed to New Hampshire Hospital, which specializes in psychiatric services. If they are seen in the community, the likelihood they鈥檒l need hospitalization drops to 20 percent, Andrus added.

Riverbend recently received a grant to start working with Concord鈥檚 police and fire departments to create an alternative drop-off center for those who need psychiatric help, or people who are seeking help for other behavioral health issues, such as addiction.

鈥淲e鈥檝e got all the right people around the table,鈥� Evers said, adding the program has been up and running for the last two to three months. Riverbend is currently working to renovate an intake building close to downtown Concord where patients can go instead of the emergency room.

Other things are being planned as well, such as trained mental health professionals riding along with the city鈥檚 police to work with people in crisis.

Whatever the case may be, health officials are hopeful that when the new model is eventually implemented, it will deliver better care to patients.

鈥淲e鈥檙e trying to get the resource that the patient needs when they need it,鈥� Hirsch said.

(Ella Nilsen can be reached at 369-3322, [email protected] or on Twitter @ella_nilsen.)