How first responders can keep patients out of the ER

As hospitals look for ways to stem emergency department (ED) overuse in order to reduce costs and improve outcomes, their efforts are increasingly getting a boost from an unlikely source--first responders.

The city of Reno, Nevada, for example, has used a $9.8 million federal grant to pursue an overhaul of its emergency medical services, Kaiser Health News reports. Through the program, paramedics are trained to conduct home visits and redirect certain patients to urgent care or mental health clinics, and a phone line run by nurses answers callers' health questions as a 911 alternative.  

Reno's efforts have saved $5.5 million in 2013 and 2014, and helped avoid 3,483 ED visits, 674 ambulance trips and 59 hospital readmissions, according to preliminary data from a University of Nevada, Reno, evaluation of the program cited by KHN.

If Medicare was able to pursue such an effort program-wide, the federal government could save $560 million, a number that could double if private insurance companies could reimburse emergency medical services to redirect non-emergency cases, a 2013 study found. Indeed, similar federally backed efforts are under way in Arizona, Connecticut and Washington state, according to KHN.

In Denver, the South Metro Fire Rescue Authority chose to revamp the ambulances themselves, FierceHealthFinance has reported. It deploys crossover SUVs known as "mobile care units" to treat non-critical patients on-scene. The idea of house calls also has caught on with hospitals, as New York City's Mount Sinai offers a "mobile acute care program" to treat certain patients in the comfort of their own homes.

There are still some barriers to these types of programs, however. In some cases first responders require government waivers or changed laws to allow them to expand their roles, and industry groups such as a the American Nurses Association have questioned whether even specially trained paramedics are qualified to provide direct care, according to KHN.

In Reno, though, emergency medical technicians are trained to take the most serious patients to the hospital, and also will transport patients there any time they request it, the article states.

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