Community Paramedicine To The Rescue!

One morning, an 84-year-old retired NYPD officer fell in his home. His wife called the Emergency Medical Service (EMS). However, rather than responding and transporting him to the Emergency Department at a local hospital, a Paramedic assessed him for trauma, evaluated his vital signs, and settled him comfortably into his bed at home. In consultation with an on-call Physician during the Paramedic visit, the patient avoided a trip to the hospital. Later that day, his personal Physician stops by the house to see how the he was doing and perhaps order home health care nursing or physical therapy visits. The patient was thrilled with the experience.

Community Paramedicine (CP) is part of a new and growing number of community response systems where emergency responders act as “physician-extenders” to provide in-home assessment and care for patients with minor injury, chronic illness, or debilitating conditions.

Community Paramedicine (CP) allows Paramedics to function outside their traditional emergency response and transport roles to help facilitate, as appropriate, other community healthcare resources and act as limited access to primary care for medically under served populations.

Within the CP Program, Licensed Paramedics and Emergency Medical Technicians (EMT) receive additional training to work as part of a community-based team of health and social services providers to connect resources. As a result, compared with traditional calls to EMS, only 22 percent of CP Program responses required transport to the hospital – meaning that 78 percent were evaluated and treated in the home. And that cost savings creates the opportunity to provide more services to patients in need.

This concept also has found application within rural communities as EMS staff extend emergency response to include other community health roles. This not only addresses gaps in primary care services, but also provides enough activity to allow the presence of EMS personnel for emergency response in very low volume areas. In such locations, Community Paramedicine Programs provide primary care in remote areas where access to physicians, clinics, and/or other providers or hospitals may be difficult.

Additionally, new programs have evolved in more urban areas that serve a similar role in the provision of community health/public health activities. In these areas, many CP Programs are designed to keep “frequent fliers” out of the emergency rooms by ensuring their health care needs are met in other ways – such as diabetic monitoring, obtaining mental health, medication management by a nurse, social services. CP Programs have the unique opportunity to be designed to meet the needs of that community through collaboration and integration with health care resources within that community. Additionally, in some areas, Paramedics may make scheduled visits to patients in their home to help prevent hospital readmissions of patients with chronic illness.

Emergency Departments (ED) across the country spend about $4.4 billion annually providing non-urgent care that could be best provided in a primary care setting such as a doctor office or clinic. The potential for cost savings and improved health outcomes, has policymakers, Emergency Medical Services (EMS), and health care providers across the nation testing strategies such as Community Paramedicine Programs to reduce the unnecessary use of Emergency Departments and provide timely and appropriate care to citizens.

Read more about it here:

Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders

Community Paramedicine

Community Paramedicine: Boon or Bane for EMS?Community Paramedicine: Boon or Bane for EMS?

Community Paramedicine Evaluation Tool

Community paramedics help medically complex homebound avoid hospitalization

EMS and Home Health: Partners in Improving Patient Outcomes and Lowering Costs

How 4 cities are making community paramedicine work for them

Introduction To Community Paramedicine

July 2013 Community Paramedicine: A Promising Model for Integrating Emergency and Primary Care

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When Things Go Wrong In Healthcare

There is just no great way to say it. Healthcare in the US is not as safe as most of us think it is. Medical errors unfortunately do happen in healthcare. There is plenty of blame to go around – but with incredibly very rare exception – bad healthcare providers intentionally hurting (or worse) patients is not one of them.

Healthcare is complex – and the system in which it operates in the US is equally complex. To make things worse, all of it is changing – constantly. So what do you do if you are injured or harmed while being cared for in a hospital?

  1. Speak with the Doctor, Nurse Manager or Risk Manager, and perhaps the Ethics Committee if appropriate. You should also have access to religious support if you wish. State your concern. You should receive help and a sincere apology. Hopefully, this will resolve your concern.
  2. Regardless, insist on disclosure – being told the truth of what happened. UnderstandOops_Stop_Sign_icon.svg that healthcare providers are human. Even the very best,  most experienced and compassionate ones make mistakes; they forget, they get tired, or distracted. They are usually devastated when an error occurs.  Keep calm and seek the whole story.
  3. Most medical error involves poor process or systems in which people work. The best way to prevent mistakes in any industry is to standardize processes and integrate human factors to make doing the right things easier and doing the wrong things impossible (or nearly so). Ask what is being changed to prevent this mistake from happening again.
  4. If you don’t feel a sense of resolution, you have the right to contact and report your concerns to The Joint Commission, CMS, the Board of Medicine, etc. and seek legal counsel.

When it comes to medical error, it is also important to understand the difference between patient satisfaction and evidenced based quality care. Both are important but it is possible to be very satisfied, while receiving care of lesser quality, and conversely to receive the best, most current evidence based best practice, and be dissatisfied with the food, bedside manner of staff, uncomfortable bed, response times, etc. At times, being unhappy about one aspect of care can influence the perception of the entire episode. In reality, one grumpy nurse, does not make the entire hospital bad.

Most importantly of all – be involved in your healthcare! Ask questions! Understand what treatment is proposed, why, and what are the risks, benefits, and alternatives! Know your medications and why you are taking them. Understand that YOU are the ultimate boss of your body and any medical interventions performed on it.

Here are just a very few examples of opportunity for error in healthcare.

Look alike and provide insight for those over 50 who continue to change the world – and for those who love them.

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Just What is the Meaning of Healthcare?

After being in the business nearly forty years, I have come to realize I no longer (and perhaps never did) understand the meaning of the word “healthcare.”wealthcare

The concept of “healthcare” is malleable; it morphs into every size, shape, application, time, and location. Healthcare can be found inside a wrecked a car along a dark desolate road and simultaneously be at home in the most lavish corporate boardroom in America. Its mere 10 letters dominate public news and the Internet while it is bantered and battered in backroom negotiations of employee benefits.

Your Healthcare is the professed focus of commercial pharmacies, the battle cry of attorneys, and the marketing motto and mission of equipment providers, researchers, mental health providers, clinics, and software companies. Every year, it is the salvation of millions and also the death knell to hundreds of thousands.

wellnessOne can hardly be faulted for being unable to describe something that by its very nature defines paradox. Healthcare is both universal and very personal; it is equal parts sincere compassion and callous power. Its reach encompasses the entirety of human experience; the spectrum of pain and pleasure, miracle and tragedy, altruism and greed.

Healthcare is there in good times and bad as it sweats in gyms, educates the public, comforts babies, responds to disasters, and holds the hand of a dying elder. A single word covers so much, means so much, and does so much.

The term also lends itself to conflicting and confusing jargon. Preventative Healthcare (prevent health – really?). Wellness Health (as opposed to the Badness variety). Alternate Healthcare (what??). These titles just never passed the transparent credibility test for

Why have we not, despite our long-standing penchant to complicate things further, made the definition clearer, more concise, and better reflective of what we do? Why can we not label categories of patient healthcare for what it is and should be?

Life Care – to promote physical, mental, and spiritual wellness and the prevention of illness or harm.
Health Maintenance – to manage and constrain chronic illness and harm.
Health Repair – to correct acute medical or surgical episodes of illness and/or injury, recovery, and rehabilitation.

Maybe then I will have a better idea of what the larger concept of Healthcare is really all about. And maybe then we can do a better job of determining how to make it all better.

Overall ranking pix provides inspiration and insight for those over 50 who continue to change the world – and for those who love them.

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Fundamental Truths of Healthcare

During my four decades in healthcare, “sacred” routine of patient safety (consisting of side rails and restraints) and concerns about making patients feel “dirty” (by wearing gloves while providing care) have disappeared.  Along the way, I replaced those concepts with comprehensive fundamental truths that include the soul touching depth and the humanity healing breadth of everything that is healthcare to me. Today a former patient600 Unimport jobs700 Protect patient700 Healthcare privilege700

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Improvement Management is the Highest Application of Change in Healthcare

Implementing and maintaining change has become an enormous challenge within healthcare. It is little wonder. Continuous improvement efforts occur within a complex industry as transformational change is rocking its long-established business model. As a result, improvement has never been more essential in all of healthcare.

With all that change, it is surprising that “Improvement Management” is seldom practiced. Management of change is required to sustain improvement, utilize limited resources, adjust to diverse healthcare settings, and ensure lasting improved performance. Therefore, Improvement Management is the highest application of change.

Disorder in healthcare contributes to loss of reimbursement, poor quality, increased costs, and potential harm to patients. Current improvement efforts require considerable time and resources of staff, yet their efforts often yield marginally effective or short-lived improvement. Improvement fails to attain full potential because lack of comprehensive integration and alignment of change into organizational operations.

In contrast, Improvement Management disseminates timely innovations and interventions throughout the healthcare organization to attain operational compliance and reduce error. This proactive approach spreads and sustains improvement by comprehensively incorporating it into operational structure and tools. Behavior change among staff is seamless as documentation, policy, procedure, job tools, patient education, consent forms, evaluations, Strategic Plans, Medical Staff Rules and Regulations, and more are all simultaneously in alignment. Surveyors find fewer discrepancies, process is better standardized, and physicians and staff spend less time on operational issues and more time with patients.

Improvement Management provides:

  • Horizontal and vertical operational support to expand successful improvement          beyond the initial project,
  • An alternative to numerous previous disappointing improvement efforts,
  • A method that adapts to diverse operations and healthcare settings,
  • A step toward Operational Excellence, and
  • The promotion of a robust culture of safety.

This guides compliance with current best practice, proactively reduces systemic causes of error, and expedites staff behavior change by:

  • Providing coordinated just-in-time tools and medical record documentation methods throughout the continuum of care,
  • Effective use of human factors,
  • Standardizing practice and process, and
  • Integrating patient safety and operational excellence throughout the organization.

Barbara Duffy, DHSc, MPH, CPHA, LHRM

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The Science of Yoga

Proving what millions of Americans have long contended, the benefits of Yoga are showing up in scientific studies today and well beyond anecdotal stories. Furthermore,Yoga is becoming an ideal healthy prescription for so many of us.

According to studies, Yoga provides:

  • Low impact cardio, resistance training, and stretching that is so important for those over the age of 50,
  • Stress relief and improved sleep,
  • Relief from some forms of depression,
  • Improved balance to reduce falls and increased flexibility,
  • Good bone health and more energy,
  • A reduced threat of death or chronic illness, and
  • An overall improved quality of life.

Yoga is non-competitive and because it uses your own body weight, you are less likely to get injured. However, it is important to know there are different levels and types of Yoga. Find one that fits where your body is now and allow Yoga to adjust to your body and abilities.

Perhaps the most important measure of the benefits of Yoga is also the most difficult to put into words or numbers in a scientific study.  “I simply feel wonderful since doing Yoga, ” said one 60 year old YMCA member.  “And I smile more often.”


Chen KM, e. (2016). Sleep quality, depression state, and health status of older adults after silver yoga exercises: cluster randomized trial. – PubMed – NCBI. Retrieved 7 February 2016, from

National Institutes of Health (NIH),. (2015). NIH video reveals the science behind yoga. Retrieved 7 February 2016, from

Sivakumar, P., Koparde, V., Varambally, S., Thirthalli, J., Varghese, M., & Hariprasad, V. et al. (2013). Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial. Indian Journal Of Psychiatry, 55(7), 364.

The Huffington Post,. (2016). 5 Health Benefits Of A Yoga Practice For Older Adults. Retrieved 7 February 2016, from

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Applying Lessons Learned from Medical Error to Everyday Life

Perhaps you have squirted a yellow packet of lemon juice onto your hot dog thinking it was mustard instead. Sometimes such mistakes are funny or just annoying – sometimes they can be very serious. Similar Look-Alike or Sound-Alike occurrences have happened quite often in healthcare. For example, a patient may mistakenly receive an incorrect medication that appeared proper at the time.  Fortunately, research has been able to determine and prevent multiple factors that contribute to errors of all types and in all places – and these  also have great application in everyday living.

For example – Where you store something matters!

In healthcare, we learned NOT to store medications alphabetically or adjacent to medications with similar names, packaging, or actions.  As an example why, consider this – In an attempt to keep bug spray away from grand children, you put it in a higher cabinet, out of reach, and right next to the cooking oil spray. Can you see the chance for a very bad (albeit insect-free) meal at some point?

Look-alikes can be readily thought to be something they definitely are not. For example – chocolate laxatives have been confused with candy, some mothballs have been mistaken for mini-marshmallows, a tube of hydro-cortisone cream resembles toothpaste, a few decongestant over the counter medications are very difficult to distinguish from red hot cake decorations, windshield washer fluid looks like several blue drinks for kids, animal crackers are fed to Fido instead of dog biscuits, and liquid pine cleaner has been accidentally poured in place of apple juice. To prevent these Look-Alike mistakes, separate and store these items in very different places – away from each other and in the case of hazardous items, not easily accessible to children – or pets!

Look-Alikes, Sound-Alikes, and Spelled-Alikes are EVERYWHERE

Here are just a few:Listerine

  • Buy by today – or bye!
  • Is yelling allowed aloud?
  • Is it their, they’re – and over there!
  • I cited the site about sight.
  • The dove dove into the bush.
  • Farmers produce the produce.
  • The insurance is invalid for the invalid.

Now, consider the challenges for those with poor vision, low literacy skills, limited attention spans, or whose primary language is not English! How important are labels, colors, and container differences when assuming the contents?

There are also cultural considerations  

For example, “once” in English is one time – while in Spanish “once” means eleven! Think of the potential for overdose with medications when translating directions on this one!

Look-Alikes and Sound-Alikes are Common with Medications

There are limits to language – and we are running low on new letters and unique names for medications. For example – Several years ago, a new medication became available to treat cometpeptic ulcers and gastric reflux.  Losec was widely used until several incidents occurred where it was confused with a very different drug – Lasix (a diuretic to reduce fluid in the body). The makers of Losec recognized this hazard and changed the name to Prilosec to reduce the potential for error.

Here are just some of many other medications at risk of being easily confused:

HumaLOG versus HumuLIN (Both are insulin, but with different onset and duration times.)

CeleXA and CeleBREX (Celexa is an antidepressant. Celebrex is an anti-inflammatory drug.)

You may have noticed that parts of these drug names are in capital

pet look alikes

Look alikes can be anywhere AND be very different!

letters.  Tall Man Letters were incorporated into similar drug names in an effort to point out differences in spelling.  If you see a drug name with Tall Man Letters, be aware there is likely something else available that has potential to be confused with it!

What to do

  • Be aware of the potential for unintentional misinterpretation!
  • Write it down and read it back when receiving important information.
  • Request others write down and read back information from you (Pizza delivery orders come to mind here!)
  • Always check your medications before leaving the pharmacy – and ask questions if you are unsure about something. This especially important as medication manufacturers may change color and size of tablets without notice to you!
  • Do not store very dissimilar but similar looking items together (such as Lysol next to the Listerine under the bathroom sink or cans of tuna fish with cans of cat food).

One last example. How do you  k(NO)w?

Here is a list of Look-Alike drug names from ISMP (Institute for Safe Medication Practices)

Also take a look at the Upstate New York Poisons Center at:

The national toll-free “Poison Help” telephone number: 1-800-222-1222.  Regardless of your location in the U.S. or its territories, dialing that number will direct your call to the nearest regional poison center.

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Feeding the Beast

I encountered a moment of truth while creating an online interactive class regarding Risk Management in healthcare recently.

I had presented information about the importance to integrate risk management thinking into everyone’s job; in essence to critically question, “what can go wrong” to proactively protect the patient from harm.   To further support the necessity for risk management, I provided recent medical error data of completely overwhelming patient harm and death numbers.

That is when I asked myself again, as I have done so many times before – how did the industry I love; one that is full of dedicated, good, altruistic people, get so far off the tracks?  Where did we lose our way?  When did anything else become more important than the patient before us?  What derailed our priorities and confused the picture and how it is we are working so hard and impacting the overall health of Americans so little.  And why, why, why did I not know??  Of course I have experienced the problems, the barriers, and the disconnects – but I have no one good answer as to the overall cause.

So, I did a Google search, thinking surely some greater mind must have an answer.  I asked why is healthcare so bad, why does healthcare kill so many people, why do so many die from healthcare in America, why aren’t we outraged about healthcare?
Here is what I found:

Anti “Obama care” articles from 2007.
Why do pharmaceutical drugs injure and kill so many people from 2004.
A gaggle of public responses with varied answers regarding bad healthcare in 2006.
Where is the outrage regarding children dying in childcare settings in Missouri from 2012.

Hundreds of thousands of patients are dying BECAUSE OF healthcare – and there is no single reason to be found!  Not even the greatest repository of human knowledge in all of human history could answer the question.

Medical error is not intentional – they are mistakes – and we in healthcare, seem to excel at producing them.  But of course there is plenty of contributing factors – records that don’t interface, medications that look alike, poor handwriting, worker fatigue, alarm fatigue, being rushed to do more with less, interruptions, human error, payer requirements, the list is endless.

Consequently, there are also ample knee-jerk reactions to affix to each symptom of a much larger malady – National Patient Safety Goals, performance improvement projects, core measures, root cause analysis, failure modes analysis, initiatives, campaigns – and still patient deaths occur BECAUSE OF healthcare.  There is no smoking gun and no troop of vigilante assassins.  Patients continue to die from a multitude of innocent errors and we keep applying shallow fixes atop an enormous epidemic of failure.

There may not be a single solution, but three truths come to mind:
1. The current approach is NOT working.  Another regulation is not going to produce miraculous results in patient survival at the hands of those juggling numerous healthcare mandates today.
2. The practice of healthcare over the past two decades has expanded in complexity beyond the capacity of the average human mind to comprehend, safely apply, and readily adapt to the onslaught of its associated change.
3. The diversity and prevalence of lethal medical error indicates the cause is not only systemic and incessantly insidious, it is pandemic in nature.  Platitudes are not going to tame this beast.  It is stealthy and ubiquitous with tentacles that reach deep into the soul of healthcare behavior.

One thing however, is apparent.  The future of all humanity is our patient – and safe healthcare requires a complimentary structure that works for, with, and beside us imperfect mortals – instead of us working to feed a ravenous and ineffective system.

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Soap and Soup for Everyone!

OK, ok. I get it. Wash your hands. Do it often and do it well. I have been an RN forever and sometimes I swear I can feel Kooties on my hands. I take advantage of every opportunity to obliterate germs as we are repeatedly told doorknobs, ink pens, key boards, phones, side rails, and elevator buttons harbor enough occult pathogens to spread disease everywhere.

Yet despite clean hands campaigns, improved environment cleaning, and stricter antibiotic management — no matter how hard we try, we are still not winning the war against this opportunistic, ubiquitous, and very destructive force.

Maybe we need to look a little closer at another source. How often do hospitalized patients wash their hands before their food tray arrives? Then consider this – how often do we provide these same patients with “finger foods” such as crackers, sandwiches, toast, etc? And then ponder this – how many other places have more c-diff spores than a hospital – just waiting to hitch a ride on a french fry?

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A Healthcare Quality Refresher Guide – by Default

Something amazing happened the other day. I found a treasure I unwittingly buried for myself five years ago.

While cleaning out a file cabinet at home, I discovered the notes I compiled while studying for my CPHQ (Certified Professional in Healthcare Quality) exam in 2009. With a quick scan of rumpled papers, I was reminded of some great information still very pertinent in 2014. While the notes are cryptic in some places, they did serve to jog my memory and dust off some neglected improvement tools, models, and methods still ready to be put to good use.  And for a moment, I graciously appreciated my poor filing habits that contributed to a Healthcare Quality Refresher Guide half a decade later.

Now I can’t wait to clean out the hall closet to find what forgotten treasures dwell there as well.

I submit the notes for your review below in hopes you find renewed tools and insights buried within!

Healthcare Quality Refresher Guide


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