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Cutting Down On ER Visits With Other Medical Options



The number of emergency-room visitsare climbing across the country and is linked to long wait times and higher mortality rates. 


Renown Health and Washoe’s ambulance provider the Regional Emergency Medical Services Authority, or REMSA, are forming an alliance to cut down on the unnecessary use of the healthcare system with the Community Health Programs. Renown Health will provide REMSA with funding to continue community-focused health services including the Nurse Health Line, Community Paramedicine, and Ambulance Transport Alternatives.


The Presidents and CEOs from Renown Health, Dr. Anthony Slonim, and from REMSA, Dean Dow, share their perspectives on how these services work with patients to understand their medical needs and to help direct them to the appropriate type of care. Dow says that these services could amount to $1.6 million in savings to the community over the next year.


Q: With unnecessary visits to the ER rising, REMSA has been working on solutions like Community Paramedicine and Ambulance Transport Alternatives. What are these services and how doe these approaches help to cut down on the burden to the healthcare system?


Dean Dow: Community Paramedicine was started in this country approximately seven years ago as a test program and a way to bring highly trained paramedics into a home setting as opposed to just in a 911, or an emergency setting, so these are paramedics that have hundreds of hours of additional training and they can work with patients in their homes to monitor their healthcare and their needs on an ongoing basis. Ambulance Transport Alternatives is a program that’s been created again to have a patient in a healthcare pathway that is the correct pathway for them. So we are able to transport patients to urgent care centers, or to mental health facilities and not always to the emergency department. Because at the end of the day, part of this process is realizing that not all patients need to go to the emergency department.



Q: ERs across the country are seeing more people showing up with conditions that don’t require emergency care, but could have been helped with a visit to a primary care doctor or to urgent care. Why are we seeing more people go to the ER and are we also seeing this happen in Reno.


Anthony Slonim: We’re absolutely seeing this in Reno. And part of the issue has to do with education. We need people to understand that there are other places where they can get appropriate care. Not everyone needs the emergency department when they have a minor illness or a minor injury, and so making sure that we can get the right people to the right setting is important for us as we embark upon this partnership. I think one of the other things that’s important is how there may be few alternatives for some categories of people. So we noticed here in Reno that our emergency department is overwhelmingly occupied with people who have mental conditions or mental illness because the community support services may not be available to care for them more effectively in alternate settings. That tends to bog down the system and then someone who comes in with chest pains, or something acute, actually [this] becomes a bigger issue to them because we have to make sure there is adequate flow through our emergency departments. 


Q: Since we are seeing more visits to the ER, some critics of the Affordable Care Act have attributed the increase to this legislation. What are your thoughts about that?


AS: Well, I think one of the things the Affordable Care Act does for us is to suggest that we need a broader approach to the health and healthcare needs of our community. The way that Renown Health is approaching that is very similar to the way REMSA is approaching it, which is all of those in the entire population is our community.  I think [that’s] one of the important parts of the collaboration [since] we will never have enough physicians and nurses alone to care for all of the health and healthcare needs of people. This is an innovative model that uses the skills and expertise of others including paramedics and nurses to help us address the needs of the community more broadly, even beyond what we’re able to do now in the walls of the hospital.


Q: Since REMSA has had many of these services in place for the last four years, what are some of the benefits that you’ve been seeing in terms of health outcomes and benefits to the community.


DD: We’ve been able to have approximately 1,400 patients in the community paramedicine program in the last three to four years. We’ve also had approximately 1,500 patients correctly managed and steered into correct healthcare pathways. Our nurse health line has received approximately 18,000 calls per year. We believe we’re on a pathway to save approximately about $1.6 million in the first twelve months of this partnership.

Anh Gray is a former contributing editor at KUNR Public Radio.
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