Responding to Patient Needs Through Paramedicine With the Sanford Care Wound Center

Fargo, ND  – Community paramedic programs are beginning to grow across the country, which is no surprise with the amount of potential benefits they offer. The programs offer a wide variety of services to patients including, but not limited to, monitoring of chronic diseases, medication management and education, and wound care.

About Sanford Health

Sanford Health, one of the largest health care systems in the United States, is dedicated to the integrated delivery of health care, genomic medicine, senior care and services, global clinics, research, and affordable insurance. Headquartered in Sioux Falls, South Dakota, the organization includes 44 hospitals, 1400 physicians, and more than 200 Good Samaritan Society senior care locations in 26 states and 9 countries. Nearly $1 billion in gifts from philanthropist Denny Sanford have transformed how Sanford Health improves the human condition.

Sanford Health in Fargo, North Dakota, boasts the newest and largest medical center in the state. It serves as a regional health care hub with 60% of patients coming from outside the metropolitan area. Sanford Health Fargo is the only Level I adult trauma center between Minneapolis (MN), Seattle (WA), Denver (CO), and Omaha (NE). It is also a Level II pediatric trauma center and an emergency air transport service center covering a 3-state area. Sanford Health Fargo is licensed for 440 inpatient beds and averages about 400 patients daily.

The Sanford Wound Care Center in Fargo averages 350 patient visits per month. The center focuses on the management of acute and chronic wounds under the direction of medical director and vascular surgeon, Warren Albrecht, DO. The staff is made of up nurse practitioner, Emily Greenstein, APRN, CNP, FACCWS, CWON; physician assistants, Cynthia Smith, PA-C, and Morgan Lien, PA-C, CWS; 5 certified wound and ostomy nurses; and 2 certified nursing assistants. 

Beginnings

A community paramedic program in Fargo began in 2014 at F-M Ambulance, a wholly owned subsidiary of Sanford Health, as a pilot project funded by the Helmsley Charitable Trust. When the program began, 4 paramedics received specialized training and an advanced certification in community paramedics at Hennepin Technical College in Minneapolis. 

Under the medical direction of Heidi Lako-Adamson, MD, the community paramedic program began providing care to patients.  The beginning focus was on those patients who were frequently readmitted to the hospital, were at high risk, and did not qualify for home care. To date, 338 patients have been enrolled in the program, with an average age of 61.6 years. Some significant wins for the patient panel included a 14.4% reduction in emergency department visits, 37.4% reduction in hospital readmission, 5.4% reduction in clinic visits, and hemoglobin A_1C levels decreased from 11.23 to 9.7 across the group.

Because of the great success of the program, the outpatient wound care center at Sanford Health Fargo began looking at how the paramedic program could benefit its patients. Wounds are often complex to treat, especially considering various patient comorbidities, and require a multidisciplinary approach to therapy.  The wound center began to look at patients who had frequent missed appointments, high readmission rates, and/or multiple social issues. 

To ensure the paramedics were comfortable and competent in treating the patients, they were able to complete 8 hours of training and education with the wound care staff. They were educated on common types of chronic wounds and a variety of advanced topical dressings. 

Consults

When the wound care center identifies a patient who would benefit from the community paramedic program, a referral is placed in the patient’s electronic medical record.  After a referral is received, the paramedic who will follow the patient comes to the patient’s appointment at the center to observe the wound care that needs to be performed. Because the services are at no cost to the patient, they are responsible for obtaining the supplies. If the patient is unable to afford the supplies, an arrangement can be made with HERO Healthcare Equipment Recycling Organization, a nonprofit medical supply organization, to assist in providing supplies.

Depending on the need of the patient, a typical visit consists of obtaining the patient’s vitals including weight, performing the necessary wound care, and educating the patient about prevention and ways to improve healing. These patients then are followed in the outpatient wound clinic on a 2- to 3-week basis.  

Results

In the past year, the community paramedic program has been able to follow 16 wound care patients. These patients were frequent no-shows to the center, were high risk for admission or readmission,  or those who needed dressing changes that were more frequent than weekly. The results showed a 55% reduction in hospitalizations. Emergency department visits were relatively unchanged, which is not surprising as most of these patients do not have primary care providers. There was a 53% reduction in no-show wound center visits. This was a huge victory for this patient population.

The implementation of the Fargo community paramedic program has shown great success when collaborating with an outpatient wound clinic. This is a program that will hopefully continue to grow across the country to serve high-risk patients and help reduce hospital readmission rates. n

A special thank you to the Sanford Wound Care Center staff: Nancy Moore, RN, CWON; Nikki Fischer-Buccholz, RN, CWON; Nikki Oliver, RN, CWON; Sarah Amundson, RN, CWON; Kaley Fisk, RN, CWON; Virginia Jones, CNA; and Jessica Nix, CAN; and the community paramedic staff: Jason Jordahl, NRP, CP; and Jason Eblen, NRP, CP.

Emily Greenstein is a nurse practitioner certified in wound and ostomy care at the Sanford Outpatient Wound Center in Fargo, ND. She serves as Co-Chair of the Wound Care Research Committee of the Association for the Advancement of Wound Care and the Media Chair of the North Central Region WOCN Nursing Society.