Case Study: Connecting Patients to Social Services

When EMS providers arrive on scene and encounter a patient with specific needs they aren’t adequately equipped to handle, what should they do? Whom should they call? In some cases, EMS agencies have developed their own community paramedic and mobile healthcare programs to address patient needs that fall outside the normal duties of EMS.

But if establishing such a program isn’t on the horizon in your area, there are a variety of patient needs that can better be handled by social service agencies already in your community. Several years ago the Columbus (OH) Fire Department, which operates a fully ALS EMS system that responds to more than 130,000 calls per year, was dealing with concerns about frequent callers—people who needed help, but not from EMS.

At the same time, Columbus Public Health (CPH) saw its home care and hospice services closed and needed to develop a new role for its social workers. In a joint effort, David Keseg, MD, FACEP, medical director for the Columbus Division of Fire, worked with Columbus Public Health officials to develop an EMS Social Service Referral Program that would become a win-win for both agencies.

The types of 9-1-1 calls deemed appropriate for CPH referrals consisted of:

• Breathing problems;

• Obesity;

• Frail elderly who fall;

• Frequent calls for personal assists;

• Non-medical calls where there is no caregiver present or an inadequate caregiver and the patient is unable to care for themselves, resulting in EMS becoming a proxy caregiver/transportation;

• Emotional and behavioral problems, including anxiety, loneliness, alcohol/drug addiction or drug-seeking.

Once in callers’ homes, EMS providers might also see poor living conditions, hoarding, an abundance of animals, social issues or family problems. And, despite poor health, patients might refuse transport.

The result was EMS services and resources being spent on problems EMS providers weren’t able to adequately address. CFD could have funded an entirely new service to take on these types of patients or trained the entire Division of Fire on how to handle these types of encounters, but both options were too costly.

Instead, CFD began its referral program with CPH, which proved more cost effective and a better use of resources. No additional money or manpower was needed, EMS providers had an option available for frustrating calls, and an existing city agency well-versed in the specific needs of these types of patients was able to step in and take over care.

Now the process for making referrals for patients with social service needs is as follows:

• EMS personnel notify their supervisor about any of their patients who meet the criteria for referral.

• The EMS supervisor completes a social service referral form and e-mails it to the Columbus Public Health—Neighborhood Health Services Social Work supervisor.

• Once the case is referred to the CPH supervisor, they assign the case to a social worker who contacts the patient. With the patient’s permission, the social worker makes a home visit and assists with trying to solve problems.

• If a social worker makes a home visit, appropriate HIPAA documentation is also obtained.

• CPH sends an acknowledgement of the referral to Columbus Division of Fire Continuous Quality Improvement.

Since the Social Service Referral Program began in 2007, referrals increased every year through 2011, the last year for which data is available. As a snapshot, in 2010, of the 118 referrals:

• 40% were frequent callers;

• 30% were for patients EMS providers had concerns about (elderly, alone, overwhelmed, etc.);

• 18% involved caregiver problems;

• 11% were for mental health problems;

• 9% were for falls;

• 8% were because of the condition of the home environment; and

• 3% were due to obesity.

Looking at a sample of 55 frequent callers and comparing the number of calls for those individuals six months prior to referral and six months after, CFD noted a 44% decrease in the number of calls, or 113 runs. Cost savings from that decrease were estimated at just over $173,000 for the six months following referral; annually savings would be nearly $350,000. And, in addition to cost savings, the real benefit was the allocation of appropriate resources for these patients and providing EMS personnel with effective tools to better perform their duties in the field.