Nebraska Study Aims to Lower Patient Readmission Rates

A Nebraska study has found a way to help lower hospital readmission rates, two ambulance company executives said in a webcast titled “Exploring the Use of Community Paramedics to Aid in Reducing Hospital readmissions at Regional West Medical Center,” hosted by the Community Paramedicine Insights Forum (CPIF).

Randy Meininger of Valley Ambulance Service in Scottsbluff, NE, and Julie Smith of the Rural Nebraska Regional Ambulance Network in Kearny, NE, conducted a pilot project from February 2013 to February 2014. The program focused on lowering readmission rates and eliminating unnecessary emergency department visits.

Smith says the patients were all chosen from one medical floor in the hospital, and their diagnoses were either congestive heart failure or pneumonia. Patients were given the choice to have home visits after their discharge. Patients who were eligible for home health services or who were going to back to a nursing home or similar type of long-term care were not eligible to participate.

Smith says the patients that participated in the program were randomly assigned either an RN or a paramedic to visit them in their home. In most cases, the same paramedic or RN completed all of the patients’ visits, Meininger says.

Meininger says even if the patient was not fully readmitted and just ended up visiting the emergency department again, they were counted as a readmission.

A total of 159 patients participated in the project. The sample group, which contained participants that were visited in their homes after discharge, had 63 people, and the comparison group, which did not get visited, had 96 people.

Of the participants in the sample group, 14.3% of them ended up readmitting, whereas 26% of the comparison group was readmitted at some point.

The sample group had nine total readmissions. Four of the readmissions were patients being seen by paramedics, and five were patients being seen by RNs.

The program also had some unexpected benefits.

Meininger says the use of electronic records proved to make the project run much more smoothly. The electronic records made it easier for paramedics and RNs to track data, and they were able to read each other’s charts and see more patient information.

Meininger also says that during the pilot program, they checked for patients’ tissue profusion. His goal in the coming months is to track this data and see if a higher percentage of patients were readmitted if they left the hospital with a certain amount of tissue profusion. If so, this could be used to track whether a patient should be discharged in the future.

One unexpected issue the program ran into was unclear directions from some clinics. Some patients were confused by what they were supposed to do for follow up, Meininger says. For example, a patient may be told to call their doctor if they experience weight gain, but visit the emergency department instead.

Meininger and Smith say they would like to continue the project in the future, and change some aspects, such as adding in a nurse navigator to give direction to the paramedics and RNs.

To listen to the presentation, visit here.