VNSNY call center nurse Wanda Lopez recently got an alert that a heart failure patient, newly discharged from Mount Sinai Health System (MSHS) to home care, was complaining of weakness and a severe headache, Lopez contacted Mount Sinai to arrange for a community paramedic to visit the patient’s home. Finding the patient badly dehydrated, the paramedic used a special app to immediately set up a three-way video conference with the VNSNY call center nurse and a physician from Mount Sinai who is specially trained and certified in online medical control.
During the encounter, the paramedic performed clinical and diagnostic assessments, including an EKG and blood glucose monitoring, and administered aspirin and intravenous saline solution under standing orders, resulting in symptom relief. The physician proceeded to complete a physical exam using the virtual technology and recommended the patient not be transferred to an emergency department (ED). Because the patient’s pacemaker responded inappropriately to normal heart rhythm, the physician also recommended an appointment with her cardiologist. The next morning, a VNSNY field nurse followed up with a home visit to assess the patient and arrange for a cardiologist’s appointment that day. Meanwhile, a potential crisis had been averted.
This coordinated in-home consultation is the centerpiece of a new Community Paramedicine collaboration between VNSNY and MSHS, in which specially trained community paramedics call on patients requiring immediate care—often avoiding the need for a trip to the ED that may otherwise have occurred. “Any patient discharged from Mount Sinai’s Manhattan facilities to VNSNY Home Care in Manhattan is eligible for the program,” explains Lorna Canlas, Project Manager with VNSNY’s Solution Development group, who is overseeing the initiative along with Yaffa Vinikoor, Quality Manager for Strategy.
If a patient in the program contacts one of VNSNY’s call center nurses with certain symptoms, an automatic pop-up in the system will prompt the nurse to activate the Community Paramedicine protocol. After arriving at the patient’s home, the paramedic loops in the VNSNY nurse and a Mount Sinai physician associated with the program. “It’s then up to the physician to decide whether home treatment will resolve the problem. If the physician decides that the patient does need ED level of care, the patient will be transported there by ambulance,” says Canlas.
Of the 11 patients who have received Community Paramedicine visits since the program’s launch this past April, all but three were successfully managed through the collaborative efforts of the VNSNY call center nurse, community paramedic and Mount Sinai physician.
The Community Paramedicine partnership is administered by Mount Sinai Health System’s DSRIP (Delivery System Reform Incentive Payment) initiative through the Mount Sinai Performing Provider System (MSPPS), part of the statewide DSRIP initiative designed to reduce New York State’s hospital readmission rates. As the first home care agency to participate in this program, VNSNY has worked closely with Mount Sinai to design guidelines and procedures. Rigorous quality reviews are done on each case, allowing the program to fine-tune its processes and optimize outcomes.
“We’re thrilled to be partnering with VNSNY on this innovative program that combines home care and emergency medical service capabilities,” says Dr. Kevin Munjal, Associate Medical Director of Prehospital Care and Clinical Champion for Care Transitions for MSPPS. “This collaboration demonstrates how health care professionals across the service provision spectrum can work together to optimize clinical care and patient experience.”
In the coming months, VNSNY will be extending the program to its Bronx home care patients who have been discharged from Mount Sinai. “This is an emerging model, both in New York State and nationwide,” notes Canlas. “It really represents a new paradigm in home health care.”