MARCH 24, 2015 Page 1 of 26 MIDDLESEX COUNTY COUNCIL COMMUNITY PARAMEDICINE PRIMARY REPORT MIDDLESEX-LONDON EMERGENCY MEDICAL SERVICES March 24, 2015 5. a - CC MARCH 24, 2015 Background Page 2 of 26 5. a - CC • The Ontario health care system is presently facing unprecedented challenges most prominent among demographics and finances • Projected that over the next twenty years the number of seniors living in Ontario will double and their average cost of health care being three times higher than that of the average person living in Ontario • Today health care in Ontario consumes 42cents of every dollar spent on provincial programs • Over the next twelve years it is estimated that this cost will increase to 70percent of the provincial budget • If the Ontario health care system continues with its past practice it is predicted that with the 2030 population, Ontario health care costs would increase by $24billion (Ontario’s Action Plan for Health Care. 2012). MARCH 24, 2015 Background Page 3 of 26 5. a - CC • In 2010/11 there were 5,582,863 recorded visits to Ontario emergency departments (Canadian Institute for Health Information) • Over 271,000 (4.85%) visits made to Ontario emergency departments that could have been treated externally • 140,000 instances accounted for in Ontario of patients re-admitted to hospital within 30 days of their original discharge (Ontario’s Action Plan for Health Care. 2012) • In 2013/14 there were 5,963,027 recorded visits to Ontario emergency departments (Canadian Institute for Health Information) • Estimated 289,000 visits made to Ontario emergency departments that could have been treated externally based on 2010/11 study results • These patients could have received appropriate and optimal care outside the emergency department at a lower cost MARCH 24, 2015 Background Page 4 of 26 5. a - CC • Paramedics are often the first, and on occasion, the only point of contact to the health care system for some patients • Paramedics repeatedly respond to calls to assist patients experiencing difficulties coping with the daily activities of living, which often require interventions beyond the paramedic scope of practice • The Province of Ontario is investing to support the development and expansion of Community Paramedicine initiatives province-wide to allow paramedics to apply their training and skills beyond the traditional role of emergency response (Ontario Expanding Community Role for Paramedics. 2014) MARCH 24, 2015 Background Page 5 of 26 5. a - CC The right care at the right time in the right place • Community Paramedicine programs will work collaboratively with numerous health care agencies to co-ordinate care for patients living with complex underlying conditions. • These programs will ultimately ensure the individual patient is receiving the right care at the right time in the right place promoting independent living while reducing unnecessary and costly emergency room visits. • Through a partnership with South West Community Care Access Centre (SWCCAC), Health Links, LHIN, CMHA, and London Police Service, and numerous other services and agencies, the Middlesex-London EMS Community Referral Program will make certain each individual patient will receive the right care, at the right time, in the right place, while consecutively decreasing the number of non-transport patient calls and emergency department visits. MARCH 24, 2015 Middlesex-London EMSPage 6 of 26 5. a - CC 13 stations 23 daily ambulances ~250 paramedics Cover: County City -2,824.9km2 - 420.57km2 Population: County -72,263 (14.1% >65+) City 366,151 (14.7% >65+) Overall 438,414 (14.6% >65+) MARCH 24, 2015 Middlesex-London EMSPage 7 of 26 5. a - CC 13 stations 23 daily ambulances ~250 paramedics Cover: County City -2,824.9km2 - 420.57km2 Population: County -72,263 (14.1% >65+) City 366,151 (14.7% >65+) Overall 438,414 (14.6% >65+) MARCH 24, 2015 Middlesex-London EMSPage 8 of 26 5. a - CC • In 2013 there were at least 94 individuals who contacted 9-1-1 for EMS >10 times • These 94 individuals resulted in at least 1082 calls in a one year period • High risk callers such as those with Mental Health Issues, Lift Assists, Diabetic Emergencies, Failure to Thrive, COPD, and CHF are at risk of potential repeat calls that Middlesex-London EMS Community Paramedicine could assist. 94 patients 10+ calls 1082 total calls MARCH 24, 2015 Middlesex-London EMSPage 9 of 26 5. a - CC Calls that could benefit from Middlesex-London EMS Community Paramedics Mental Health 5% Lift Assist 4% 2% 14% Diabetic 54% Failure to Thrive 21% COPD CHF MARCH 24, 2015 10 of 26 Middlesex-London EMSPageCall Status Report 5. a - CC Total Calls 80,000 79,000 78,932 78,000 77,000 Increase of 5.9% 76,000 75,000 74,000 74,244 73,000 72,000 71,000 2013 2014 MARCH 24, 2015 11 of 26 Middlesex-London EMSPageCall Status Report 5. a - CC Age Demographics Comparison 8000 7000 ePCR Count 6000 5000 4000 3000 2000 2013 1000 2014 0 Mean of 49.9% generated calls from patient >60 years MARCH 24, 2015 12 of 26 Middlesex-London EMSPageCall Status Report 5. a - CC Mental Health Calls 2,680 2,660 2,654 2,640 2,620 Increase of 3.9% 2,600 2,580 2,560 2,540 2,555 2,520 2,500 2013 2014 Mental health account for 5.425% of total patient calls MARCH 24, 2015 13 of 26 Middlesex-London EMSPageCall Status Report 5. a - CC Lift Assist Resulting in Refusal of Service Lift Assist Increase of 13.5% 904 ePCR Count 950 900 850 2014 799 800 2013 750 700 911 Calls for MLEMS 2013 2014 MARCH 24, 2015 14 of 26 Middlesex-London EMSPageCall Status Report 5. a - CC Lift Assist 250 223 200 188 216 182 ePCR Count 2013 150 2014 142 138 137 113 100 66 74 73 49 50 37 22 0 Year: 31-40 Year: 41-50 Year: 51-60 Year: 60-61 Year: 71-80 Year: 81-90 Year: 91-100 70% generated calls >60 years MARCH 24, 2015 15 of 26 Middlesex-London EMSPageCall Status Report 5. a - CC Cherryhill Village Call Status Comparison Breakdown 1147 1200 867 ePCR Count 1000 479 800 600 400 200 0 117 454 Cherryhill Blvd 343 208 180 121 Cherryhill Circle Cherryhill Place 2013 Increase of 35% 112 Westfield Drive 2014 2014 2013 Total MARCH 24, 2015 Page 16 of 26 COMMUNITY PARAMEDICINE PROGRAM MIDDLESEX-LONDON EMERGENCY MEDICAL SERVICES 5. a - CC MARCH 24, 2015 Page 17 of 26 Community Paramedicine Program 5. a - CC • Immediately engaged key stakeholders, comparable paramedic services, community support agencies/services • Researched existing/developing programs • Consulted with local Base Hospital Group, Family Health Teams, Primary Lead Physicians • To date MLEMS has consulted/partnered with +20 external resources: Dr. M. Lewell, Dr. M. Peddle, Dr. G. Schacter, South West Community Care Access Center, Canadian Mental Health Association, LHSC Director of Victoria Emergency Department, Director of LHSC Mental Health, Thames Valley Family Health Team, London Family Health Team, London Police Service, Age Friendly London, Right at Home, South West Local Health Integration Network Emergency Department Project Lead, 211, thehealthline.ca, Interdev, Middlesex-London Health Unit Guelph EMS, Hamilton EMS, Oxford EMS, Toronto EMS, Winnipeg EMS, York EMS, MARCH 24, 2015 Page 18 of 26 Community Paramedicine Program 5. a - CC 3 new MLEMS CP programs have been developed to based around the following: PREDICTION CONSENT ADVOCACY MARCH 24, 2015 Page 19 of 26 Community Paramedicine Program 5. a - CC Program #1 Paramedic Referral to CCAC • Based off the MOHLTC requirement of utilization of the PERIL assessment • Provides paramedics with the additional knowledge, training, and tools to identify patients for electronic referral to CCAC for additional external support services • Complimented with two other assessment tools to ensure thorough and informed decision Paramedics Assessing Elders Risk for Independence Loss 1) Is there any reason that might cause you to believe the patient cannot be safely discharged [or ROS]? 2) Are the patients medications disorganized? 3) Has the patient called 9-1-1 in <30days? 3/3 “Yes” – 93% chance the patient will have an adverse outcome in <30days 2/3 “Yes” – 54% chance the patient will have an adverse outcome in <30days MARCH 24, 2015 Page 20 of 26 Community Paramedicine Program 5. a - CC Program #2 Community Paramedicine Refusal of Service Follow-up • Previously any patient who refused treatment/transport and sign a refusal of service form was provided with any follow-up • This program provides quality assurance for all patients who refuse treatment/transport against paramedics advice • Paramedics now have the ability to make an informed decision based on the mechanism of injury and potential adverse outcome with the patient and provide electronic notification to the Community Paramedicine Program for a follow-up (phone or home visit) MARCH 24, 2015 Page 21 of 26 Community Paramedicine Program 5. a - CC Program #3 Crisis Mobile Team Referral • MLEMS has a high call volume of patients dealing with mental health issues • Mental health contributes to 54% of repeat callers • This program provides quality assurance for those patients suffering from mental health issues who refuse treatment/transport against paramedics advice • Paramedics now have the ability to make an informed decision based on specific inclusion/exclusion criteria and activate the CMHA Crisis Mobile Team for request to respond to the scene to conduct a crisis intervention • This allows mental health patients who meet the criteria to be provided with the appropriate care in the safety of their residence MARCH 24, 2015 Page 22 of 26 Community Paramedicine Program 5. a - CC In Development 211 & London Police Service • Through partnership and participation with the Middlesex-London EMS Community Referral Program, the London Police Service frontline staff will be able to identify civilians experiencing difficulty coping with daily activities of life • Through this program police officers will be able to advocate and refer a person based on criteria and be able to complete a tele-referral through 211 • The 211 information and referral specialist will receive the police assessment of the situation and connect them with SWCCAC, or an alternative appropriate community based agency for follow-up MARCH 24, 2015 Page 23 of 26 Community Paramedicine Program By LPS having the capability to refer persons requiring additional support services, collectively we will be able to: 1. Improve the quality of life of the persons 2. Increase the persons longevity of independence 3. Reduce the number of LPS request for EMS assessments 5. a - CC MARCH 24, 2015 Page 24 of 26 The right care at the right time in the right place MIDDLESEX-LONDON EMERGENCY MEDICAL SERVICES 5. a - CC MARCH 24, 2015 Page 25 of 26 5. a - CC MARCH 24, 2015 Page 26 of 26 Thank You MIDDLESEX-LONDON EMERGENCY MEDICAL SERVICES 5. a - CC
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