Download CCW 16-186 - County of Simcoe

COUNTY OF SIMCOE
To:
COMMITTEE OF THE WHOLE
Section:
Consent - Human Services - Paramedic Services
Item Number:
CCW 16-186
Meeting Date:
April 26, 2016
Subject:
Targeted Response Unit - Community Paramedicine Home Visit Pilot Update
Recommendation:
THAT Item CCW 16-186, being an update on the status of the Targeted Response Unit and the
Community Paramedicine Home Visit Pilot Program, be received for information.
Executive Summary:
Item CCW 15-346 (October 2015), and subsequent 2016 budget approval supported the placement of
a Targeted Response Unit in Ramara for a one (1) year trial period to measure the impact on
emergency response times. With the response unit dedicated to Ramara Township since January
2016, the response time to our highest priority calls has significantly improved in the first quarter of
2016 compared to 2015.
It was identified in Item CCW 15-346 that, due to the low emergency call volume in the Ramara area,
there may be opportunities for paramedics to reduce 9-1-1 calls and patient transports to the
emergency department for patients suffering from chronic diseases through the implementation of a
home visit program. Further to this, 90 chronic disease patients who live in Ramara have been
identified by their family physician as candidates for a home visit pilot. Following the provision of
training to selected paramedics, home visits to consenting patients commenced on April 18, 2016 as
part of the targeted response unit pilot program in Ramara.
Background/Analysis:
Code 4 Response Time Performance in Ramara (Jan 1 – March 31, 2016)
The placement of the response unit in Ramara commenced January 2016. The chart immediately
below shows the improvement in the County of Simcoe Paramedic Services for the highest priority calls
(Priority 4) response time comparing Q1 2015 to Q1 2016 in Ramara Township. Staff will continue to
monitor & report the Priority 4 response time in Ramara for the remainder of the pilot.
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The following chart illustrates the overall average response times for the highest priority calls (Priority 4)
in Ramara Township taking into account all responding paramedic services.
Community Paramedic Home Visits
As outlined in Item CCW 14-359 (September 2014), the targeted response unit home visit program will
consist of an initial visit and follow-up visits by the Community Paramedic with chronic disease patients
identified & recruited by their primary care physician. A letter has been sent to 90 patients who have
been identified by 17 primary physicians from the Couchiching Family Health Team. As of the writing of
this report, 71 patients have been identified as residing within Ramara Township. Many of these
patients have been contacted and scheduled for initial assessment in their home with a Community
Paramedic.
During home visits, paramedics review the patient’s medical history and undertake a physical exam
based on disease-specific elements. Findings will be recorded directly into the electronic medical
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record (eMR) which is accessible to the patient’s primary physician. Follow-up visits can be prompted
by the patient, the paramedic or the primary physician depending on the patient’s health. During home
visits, the patient will be provided an information package that encourages them to notify their primary
physician if they have any concerns with their current condition as the first line of contact. The primary
physician can then request a follow-up assessment by the Community Paramedic.
When exploring the concept of a targeted response unit in Ramara to look for opportunities for
Community Paramedicine between 911 calls, staff reviewed Ramara and Orillia area paramedic
transport call data for the period of January 1 to September 30, 2015. Frequent users for this nine (9)
month period were defined as calling 911 for Paramedic Services four (4) or more times. On initial
review, five (5) of the patients identified by the Couchiching Family Health Team for the home visit pilot
were transported to an ED by the County of Simcoe Paramedic Services between January and
September 2015. Neighbouring Paramedic Services will be approached to request sharing of data for
the home visit patient group to develop a comprehensive understanding of the 911 & hospital system
demand.
Community Paramedic Selection & Training
Further to Item CCW 16-010 (January), additional one-time Community Paramedicine funding received
from the Ministry of Health and Long Term Care (MOHLTC) in November 2015 was used to fund seven
(7) weeks of education for three (3) frontline Paramedics and one (1) Clinical Supervisor in chronic
disease management to support the home visit program as part of the targeted response unit trial.
The recruitment process was completed and three (3) front line Paramedics were selected for the home
visit pilot program. The selected paramedics successfully completed their training through Centennial
College including a total of seven (7) weeks of training incorporating didactic work, working in chronic
disease and family physician clinics, health teaching programming and in field ride-outs in an existing
home visit program. They were then put through final testing which incorporated a written exam and a
practical Objective Structured Clinical Evaluation (OSCE). The OSCE consisted of five (5) practical
scenarios inclusive of documentation/physician reporting. Areas of focus included accurate
assessment and safe management of patients in their homes and identification of when physician
consultations are indicated.
Memorandum of Agreement
The County of Simcoe and the Couchiching Family Health Team have signed a Memorandum of
Agreement authorized in Item CCW 16-048 (January). The Memorandum of Agreement outlines the
patient enrolment process, electronic medical record sharing of patient information, medical directives
and performance reporting data requirements.
Scope of Practice
The Home Visit Community Paramedics conduct a detailed patient examination with special attention
given to their identified disease process for which the patients were enrolled in the program. These
chronic diseases include Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease
(COPD) and Diabetes Mellitus (DM). Hand held blood testing equipment will be used to provide realtime lab quality blood chemistry results in minutes. The lab values can be reviewed with the primary
physician by the Community Paramedic to assist with decision making about necessary treatments or
medication adjustments that can be made in the home. Monitoring of other indicators of health such as
weight, medication use, blood pressure, other vital signs and other assessment findings such as lung
and heart sounds as well as health coaching and risk reduction. The paramedic findings will be directly
entered by the paramedic into the patient’s electronic medical records and serve to keep their
physicians aware of changes in their health status. Some home interventions and treatments can
include IV/fluid therapy, evaluation of the impacts of current mediation regimes and adjusting
medications on the spot when indicated. The paramedics can also initiate antibiotic treatment for chest
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infections, medications to reduce water retention and decrease load on the heart and adjust patient
insulin levels as an example.
Home Visit Response Unit Deployment
The targeted response unit is deployed in Ramara Township twelve (12) hours per day, seven (7) days
per week. The commencement of home visits began on April 18, 2016. Staff are taking steps to
manage the deployment of resources so as to mitigate impacts on 911 responses in the area.
Evaluation
Program evaluation components will be shared between the County and the Couchiching Family Health
Team to evaluate program success. These components include the number of Paramedic Service
transports to an emergency department, emergency department visits & admissions prior to the home
visit pilot and after the commencement of the home visit pilot as well as patient & primary physician
satisfaction.
Staff will continue to provide quarterly updates on the impact of the Targeted Response Unit –
Community Paramedicine Home Visit Pilot Program.
County-wide Response Times:
As a result of the 2016 budget deliberations, County of Simcoe Paramedic Services implemented
additional 12 hour Paramedic Rapid Response Units in the Town of Penetanguishene and in the Town
of Innisfil. In review of response times during the first quarter of 2016, improvements in response
times have been noted as a result of these additional resources. Please refer to Schedule 1 of this Item
that outlines average priority four (4) response times for the first quarter of 2016 across local
municipalities in comparison to the same period in 2015.
Schedule 2 of this Item outlines the overall call volume comparison for the first quarter of 2015 versus
2016. There is an overall 6.2 % increase in call responses during this timeframe.
Financial and Resource Implications:
Funding for Community Paramedicine initiatives was initially announced in September 2014 with an
initial deadline for use of the funds by August 31, 2015. This date was subsequently extended to
October 31 2015 then again to March 31, 2016 with additional funds being allocated as outlined in Item
CCW 16-010. On April 20, 2016 the Minister of Health and Long Term Care announced funding for
Community Paramedicine initiatives would be continued through to March 31, 2017 (See Schedule 3).
Details related to the funding continuation have not been disclosed as of the writing of this Item.
Ministry funding will offset costs associated with the Community Paramedicine Home Visit Pilot
Program. This funding supported the training tuition costs of $4,000 per person, paramedic backfill
costs to staff the paramedic units while staff were away at training and will further support equipment
purchases of $15,000.
Relationship to Corporate Strategies:
Strengthen Social, Health and Educational Opportunities: Establish partnerships to identify
opportunities for strengthening human services and education to support improved health and wellbeing for our residents.
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Reference Documents:
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
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CCW 14-359 (September 23, 2014)
CCW 15-346 (Oct 13, 2015)
CCW 16-010 (Jan 12, 2016)
Attachments:
Schedule 1 – Average Q-1 Priority Four Response Times by Local Municipality 2015 v 2016
Schedule 1.pdf
Schedule 2 – Q-1 Call volume by Local Municipality 2015 v 2016
Schedule 2.pdf
Schedule 3 – Correspondence from Ministry of Health re: Funding Extension
Schedule 3.pdf
Prepared By: Merideth Morrison, Deputy Chief of Performance, Quality and Development
Andrew Robert, Director and Chief, Paramedic Services
Approvals:
Date
Jane Sinclair, General Manager, Health & Emergency Services
Trevor Wilcox, General Manager, Corporate Performance
Mark Aitken, Chief Administrative Officer
April 29, 2016
May 3, 2016
May 3, 2016