Ambulance Facilitated In-Home Health Care (An expansion of the CARE-PACT model)

One possible solution to the emergency workload issue is to expand on the already highly successful CARE-PACT program. Those who have used it will recognise how valuable it is in providing a more appropriate level of care to our aged-care residents. Keeping carefully screened residents in their facilities avoids the risk of exposure to nosocomial infections, and often significant increases patient comfort, as well as the added benefit of reduction of workload on emergency departments.

There is no reason a similar program could not be implemented for at risk groups in the community as well. Why should an elderly patient at home be forced to leave and sit for hours in the emergency department, for a skin tear repair, or non-complicated urinary tract infection? These are the patients that can take substantial time in an emergency department, and can be just as effectively managed out of hospital.

I suggest the introduction of a QAS based home care program. Ambulance Facilitated In-Home Health Care (AFIHC). AFICH would entail a medical officer (similar to a doctor working on the HARU unit) who is interested in low acuity patient care, who responds in a QAS vehicle with an extended-scope ACPII (or LARU officer). Where on road paramedics identify a patient in a safe home environment who would be suitable for in home treatment (such as first aid/wound care, basic prescriptions, referrals for tests such as urinalysis, regular blood tests, simple imaging) they may call AFICH and consult with the medical practioner to confirm if the patient is suitable. Where the patient is suitable the AFICH unit may be dispatched to assess and manage the patient at home, in the same way the CARE-PACT team can assess and treat patients in aged-care facilities.

This program would not need to be limited to elderly patients, as there are other at-risk patient groups who would benefit, such as in-home disabled patients who live with carers or family. These are also patients that don’t need to be removed from their environment or regular care, and often spend hours both on the ramp with QAS, and in hospital beds where they require additional staff to continually monitor and assist them.

Why the contribution is important

The introduction of AFICH would allow a select population of patients to remain in their homes and receive appropriate health care. The benefits can be considered on many fronts:

  • Increased patient comfort
  • Increased patient access to out of hospital health care for patients unable to attend GP clinics
  • Decreased patient exposure to nosocomial infections
  • Decreased demand on acute ambulances (as with CAREPACT a patient identified as safe to refer to AFICH can remain at home to await the AFICH unit while the acute crew is free to respond to another job)
  • Decreased ramping of acute ambulances (patients such as disabled patients from care homes are often deemed unsafe to be left unattended, requiring an acute ambulance to ramp in the ED regardless of the reason for patient presentation; elderly patients who often live independently at home are deemed unsafe to wait in a hospital waiting room, also resulting in unnecessary ramping)
  • Decreased emergency bed demand (many of these patients often endure timeconsuming processes, such as awaiting a test result or for a doctor to be free to authorise discharge, resulting in delays for other patients to access the bed)
  • Decreased staff demand in hospital (patients such as disabled patients often require a staff member to remain with them for the duration of their visit, so too is the case with home dementia patients – while normally safe with their carers at home they are suddenly at increased risk of wandering or confusion in hospital and may require dedicated staff)

by Tony on August 20, 2019 at 01:18PM

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Comments

  • Posted by Mwann August 23, 2019 at 07:56

    hay there Tony,

    Love the Idea, this is a process that the LARU educators, LARU officers are passionate in moving towards. With some of us perusing masters level of education for this reason. We see the need to start to work as a health collaborative, utilizing increased skills and knowledge of paramedics, combining that with referral and or phone/in-person consult with NP/MO for high level care within the home. If hospitalization is not required, referral letters and documentation sent through to the substantive GP. This program would have an impact on all facets of the health care system. This program has been utilized internationally, London has Paramedic practitioners in the field that work at a similar level to NP, this, with the ability to consult, include MO/GP/NP into care of the pt. would be something that i know some of the LARU officers would jump at.

    For some of us this is our overwhelming passion.

    look forward to hearing from you.
    Mwann
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