Ahead of the Curve: How the Crisis Center in Tampa Bay Quickly Reduces Hospital Readmissions
Gary Downs is a community paramedic for the Crisis Center of Tampa Bay’s community paramedicine program. The Florida based organization launched this new program in 2018 through the support of the Florida Blue Foundation.
Gary knew early on that a shift was underway from traditional medicine and techniques to something more computerized, and he wanted to get ahead of the curve as soon as possible. Emergency room visits and hospital readmissions for patients with chronic medical conditions were ongoing, expensive problems that affected community paramedicine resources.
At the same time, paramedics were filling out endless paperwork when responding to patients, a time-consuming process that contributed to potential errors in note-taking as well as an increased risk of patients returning to the hospital.
“We see 15 to 20 patients a week, many of them elderly and with complex, chronic medical conditions, such as diabetes and chronic obstructive pulmonary disease, and I had to do everything by hand, complete a narrative by scratch every time for every visit,” said Downs. “I had to print out questionnaires asking about their symptoms, transfers notes by email. That all changed when we started using HealthCall.”
The Crisis Center of Tampa Bay adopted HealthCall’s patented, cloud-based care coordination platform in January 2019. Already, this more data-driven approach during the first six months of use has led to the center experiencing:
- an 86.32% overall reduction in hospital visits
- an 87.61% reduction in emergency room visits
- an 83.08% reduction in patients who were admitted overnight to be observed
- an 85.82% reduction in inpatient admissions
How does this kind of software, utilizing longitudinal charting and care plans, work and how did it drive down hospital visits so quickly? What happened was that paramedicine united critical patient data across incidents of care, allowing paramedics to proactively spot subtle changes in key signs and symptoms specific to individual patient needs.
Instead of going to a patient’s home with paper and pen in hand, Downs now opens up a laptop and logs into the interactive program where he finds all of the patient’s recent medical history in one place, including key data points such as vital signs and weight changes from previous visits. Having critical data in one location helps Downs more quickly identify trends or changes in patterns, which can then help him make adjustments so that the patient’s treatment is more targeted.
For example, thanks to longitudinal charting, Downs identified that one patient with heart failure had gained a significant amount of weight since the last visit, suggesting the patient was retaining fluid. Instead of a costly visit to the hospital, Downs was able to contact the patient’s doctors who were then able to make adjustments in care without bringing the patient to the hospital. Downs was also able to more carefully track the patient’s progress with three follow-up visits to be sure the treatment was working and the weight gain was indeed going down.
Care Plans help Downs and his colleagues follow best practices based upon evidence based medicine for specific chronic diseases. This helps, for example, preempt a Day 12 exacerbation, which data shows is the window of time after hospital discharge when a heart failure patient is at a high risk for readmission. Moreover, after 30 days of participating in the center’s paramedicine program, patients answer a quality-of-life survey, which becomes part of their record and helps determine if paramedicine oversight needs to continue.
“We can now better track them and know when day 12 is approaching after they leave the hospital,” said Downs, “so we call them on Day 10 to get ahead of the problems, see if an extra visit is warranted. Just that one extra phone call has made a world of difference for us. We don’t miss a thing now.”
In addition to paramedicine services, the Crisis Center of Tampa Bay provides basic life support ambulance service in Tampa through its TransCare division. It also answers suicide and crisis calls 24 hours a day through a telephone contact center, provides trauma counseling, works with sexual assault survivors, and operates the Florida Veterans Support Line.