EMS Connect Fallers to Community Resources June 7, 2018
Objectives Brief background: Goal of NEW Regional Trauma Advisory Council (RTAC) for injury prevention Goal of Brown County Prevention Coalition specific to falls prevention Background that led to development of electronic application for EMS to refer a faller to community services Overview of the application and how it works Pilot and Implementation results with Green Bay Metro Fire Department (GBMETROFD) What s next - future plans Q&A
Brief Background on What is RTAC A Regional Trauma Advisory Council (RTAC) is an organized group of health care entities and others who are interested in organizing and improving trauma care in a specified region of Wisconsin. The purpose of an RTAC is to develop, implement, and monitor a regional trauma system plan to facilitate trauma system networking within a region. RTAC membership may include, but is not limited to, hospitals, physicians, nurses, Emergency Medical Service (EMS) providers and their medical directors, rehabilitation facilities, communications centers, injury prevention organizations, and community groups. RTACs collaborate with the State Trauma Advisory Council (STAC), the Department of Health Services Injury Prevention Program, and all other entities involved with, and affected by, injury.
NEW RTAC Injury Prevention The North East Wisconsin (NEW)RTAC focus is on injury prevention, reducing the severity of injuries, and decreasing the number of deaths. Our objective is to optimize the quality of care and outcomes for all trauma patients. The patient is the focus of this organization. We also believe that education of trauma providers on all levels is essential. NEW RTAC Region 3 includes 7 counties: Brown, Door, Florence, Kewaunee, Manitowoc, Marinette, Oconto Falls make up the highest % of trauma cases in Region 3
RTAC Regions
BC Prevention Coalition - Fall Prevention Goal: Reduce falls among the older adult population Objective: Create/Continue robust repeat faller program in multiple community settings
Falls Data among 4 Green Bay Emergency Departments 2013 = 21/day 2016 = 23/day Ages 65+ make up 36% of falls ED charges Source: WI Hospital Association, reported by Cheryl Czech 9.5.17 for BC Prevention Coalition. Data reflects patients that enter thru the Green Bay Emergency Rooms with any diagnosis code for accidental falls (E880-E888 or W00-W19)
Additional community input shaped an EMS intervention: High cost of fall pick-up calls (engine, 3 staff, and workers comp) Interest for EMS to connect faller (at bedside) to community resources who could help prevent a repeat fall: ADRC APS Building Inspector
9-1-1 Call for help because of fall EMS Assessment of Need Address Immediate Need Injury. Medical Transport to ER No injury. Non-Medical Service Call for Pick-up of faller: an engine and 3 staff Patient discharged w/out services referred to ADRCBC via fax when patient consents Patient consent Referral to ADRCBC Referral to APS, Bldg Inspector
Pilot - Process Background Background: Engines are sent if no injury indicated on 911 call and person just needs pick-up assistance. GB Metro FD following non-phi process as no medical treatment rendered and option for patient to refuse referral to ADRC Criteria for pilot referral to ADRC: age 60+, living in own home or apt Referral to ADRC excludes: nursing homes, adult group home, acute drug and/or alcohol
Pilot - Process Background Electronic Referral: emailed on site at bedside by EMS to ADRC general email Quantity Estimate: GBMetroFD averages 10-12/week on non-medical side, of those, actual referrals to ADRC approximately 1 per month Provided by EMS to patient on site: ADRC general brochure + fall prevention brochure explained by EMS and left with patient whether or not patient consented to be referred to ADRC EMS Script: EMS training explains who to refer and not to refer, no cost to patient for ADRC Information and assistance; ADRC goal to help determine supports to keep patient living independent & safe at home and help prevent repeat fall
Pilot - Process Background Created Jotform Application: RTAC - Dave Taylor, Mike Orlando Testing Application: Installed on station computers and tests submitted on all GB Metro FD computers to ADRC EMS Training: 3-6 days to reach all shifts among 8 stations, approximately 200 staff. ADRC Training: Front desk/office Assistants, I&A staff person assigned Pilot Timeline & Evaluation: 90 day pilot, Sept 2016- Nov, 2016
Pilot - Process Background Pilot Goal: Utilization of system: a.) EMS recognize referral, b.) fill out referral form c.) send it to ADRC d.) tracking outcomes Pilot Evaluation Report: Evaluation December 2016 ADRC Feedback loop: # of patient consents both y/n (ADRC receipt of no s for pilot stage only), # accepted ADRC, declined ADRC, unable to reach by ADRC, or pending. Integrated as normal business: Evaluation provided to stakeholders and program implemented January 2017
EMS Provide Two Brochures to Patient General ADRC of BC Brochure
Fall Prevention Brochure
How ADRC BC is notified of Referral Receipt generated to ADRC general email Bc.adrc@co.brown.wi.us Checked daily M-F and receipt forwarded to assigned staff to ensure follow-up to customer
Example of High level View for ADRC
Detail of EMS Referral to ADRC What can be viewed by ADRC assigned staff who is given username and password for protected site
Data Fields for Referral to APS or Building Inspector
Example of Marinette County
Another Community Example
Example of receipt received by EMS staff person who submitted the referral.
Live link to Jotform https://form.jotform.com/62013967585160
Jotform - Adaptation to Another EMS User
The application links ADRC BC Email to BC EMS Service Provider
Cost of Jotform
JotForm HIPAA Business Associate Agreement Protected Health Information
What Happens to Referral at ADRC ADRC Information & Assistance Specialist (I&A) reviews electronic referral and checks SAMs database to determine if patient is known to ADRC If known to ADRC, I&A reviews when the last contact was, and if contact has been made within 30 days refers back to the Information and Assistance Specialist working with customer. If the customer has not had recent contact Megan will call customer and talk about their recent fall and connection to supports/programs/services If on Family Care, I&A contacts the customer and encourages he/she to talk with their care manager about their recent fall. If customer wants assistance with calling their care manager writer will do a 3 way call
ADRC Tracking (SAMS) Database Call Type: Incoming referral via Jotform is captured as Email/Electronic. ADRC I&A use Outgoing when placing a call to the customer. ADRC Outcomes: Information and Assistance and Options Counseling (if more than one resource is discussed). Topics: Health Promotion is selected when the initial fall referral is received. After meeting with the customer, I&A will select all topics that apply based on resources shared. Notes: I&A summarizes the telephone call or home visit and provides follow-up if customer is interested
ADRC Tracking EMS Provider Date of referral Customer Name Location of fall Cause of fall Memory Concerns Known to ADRC Family Care Participant Call results 3 month follow-up contact
Results As of 1.10.18 GB Metro FD made 41 referrals (average of 2.5/month) 56% to APS or Building Inspector 44% to ADRC Of ADRC referrals, 28% accepted ADRC contact
Next Steps Expansion to other EMS providers in NEW RTAC Region 3 EMS training refresher in fall Create EMS training video Check-ins: sharing learnings, review the data for opportunity to improve the outcomes
Thank You Dave Taylor, FF/CCT-Paramedic, FP-C, NEW RTAC Coordinator, State of WI, Region 3 (Manitowoc, Brown, Kewaunee, Door, Oconto, Marinette, Florence County), newrtac@gmail.com, (920)373-1083 Barb Michaels, RN, Prevention Coordinator, ADRC of Brown County, michaels_ba@co.brown.wi.us, (920)448-4333
Questions?