Excellence in EMS Integration Award: This award recognizes a non-EMS organization that has developed and implemented a partnership with EMS organizations that have demonstrated enhancement of patient experience of care, improved patient outcomes, or reduced the cost of healthcare.

Description
Texas Health Resources – Harris Methodist Fort Worth (THR) had a problem.  Many patients in their crowded emergency department during the pandemic were being held in ‘observation’ status so healthcare practitioners could monitor the patient’s condition while they made arrangements for post-discharge follow-up care.    These patients were occupying precious ED beds, and required hospital staff time to monitor while they were in observation status.  Their ED EMS Liaison had an idea!  Would an innovative healthcare integration with MedStar to provide timely follow up care in the patient’s residence facilitate the discharge of these observation patients?  This would assure a safe and timely transition to the patient’s in-home, while assuring the patient was medically monitored, a home safety assessment and social determinant of health assessed, provide a 24/7 resource for the patient, if needed, and help assure the patient is scheduled for their follow-up medical appointment, AND alleviate hospital capacity issues.   

Of course, MedStar agreed, and over the course of 2 weeks, the two healthcare entities designed and implemented the “Observation Admission Avoidance Program”.   

Under this program, THR staff identify a patient who could be clinically and socially managed safely in an out of hospital setting, with proper medical support.  A referral is made to MedStar via a specialized electronic notification.  Within an hour, a MedStar Critical Care/Community Paramedic (CCP) arrives at the ED, locates the patient, and receives report from the lead clinician caring for the patient.  The hospital and MedStar staff agree on the clinical and social goals for the patient over the next 5 – 7 days.  The MedStar CCP explains they will receive follow-up care at home by MedStar, and confirm the first “Safe Landing” appointment, usually within 24 hours of discharge.   

The patient is then discharged from the hospital, and for the next 5-7 days, the patient is visited by MedStar MHPs to assure care plan compliance, a safe environment, confirmation and attendance at follow-up medical care appointments, and prevention of a return ED visit.

Organization Overview
Texas Health Harris Methodist Hospital Fort Worth is a 726 bed acute care hospital with a longstanding history of providing advanced medical care.    

Serving North Texas as a designated Emergency Center of Excellence by Emergency Excellence, the hospital has also been awarded the highest advanced certification by The Joint Commission as a Comprehensive Stroke Center and is the first hospital in the country to earn the prestigious designation as a Joint Commission Primary Heart Attack Center.   Additionally, it is only the second hospital in the nation to earn the Gold Seal of Approval for Brain Tumor Certification by The Joint Commission. They also offer outstanding care for growing families and have been voted the "Best Place to Have a Baby" 20 times by readers of Fort Worth Child magazine. After 90 years of service, their commitment to the growing community remains strong.

Date of Implementation: January 8, 2021

Number & Demographics of Patients/Members
32 patients who would have normally been held in 'observation' status in the ED, but are able to be discharged home, with safety-net follow up care by MedStar.

Description of Outcomes / Utilization / Change
Of the 32 patients enrolled, none have experienced a repeat ED visit, 75 social determinants of health were identified and addressed, with the most common being compliance with prescribed medications and follow-up physician appointments.  The patient’s reported an average 40% improvement in their overall health status during the enrollment, and patient experience scores for the program are 100%.   

The program is still on-going with more patients being enrolled every day.

Supporting Links
https://www.medstar911.org/wp-content/uploads/2021/05/May-2021-MIH-Board-Report-Updated.pdf     https://www.medstar911.org/wp-content/uploads/2021/05/Obs-Admit-Avoidance-Overview.pdf