Transporting to an urgent care

[Just Plain Ruff]

Is it time that EMS can start to transport to an Urgent Care facility?  Should ambulances be able to routinely transport patients to lower acuity facilities if the patients condition warrants it?

 

Take a look at this article and see what you think!!!

http://www.hhnmag.com/articles/8238-call-an-ambulance-for-care?utm_campaign=042917&utm_medium=email&eid=302381567&bid=1740908#.WQX4PMmPuZ8.linkedin

[Arctickat]

Why not? Isn't that what we've been supposed to do for decades?

We already treat and release in the home.

"Transport to the nearest APPROPRIATE medical facility"

Why does that have to be an ER? We transport to nursing stations rather than hospitals on a routine basis. Many communities have a primary health centre rather than a hospital, and often the ambulance transports to the nursing centre.

Edited May 22, 2017 by Arctickat

[Just Plain Ruff]

i completely agree but do we?  are we able to?  Can we?  

how many services "CAN" transport to a urgent care center?  I don't know of any services in my area that are able to transport to urgent care facilities and I believe its high time that we begin to be able to.  

I also think that Urgent Care facilities are pushing back against this though.  

What if the patient demands to be transported to an UC facility?  Can we refuse to transport them there?  If it's an appropriate facility then is it wrong.  

[paramatt_]

1 hour ago, Arctickat said:

"Transport to the nearest APPROPRIATE medical facility".

This should be the norm. Granted all services are different, but generally speaking, the 'you call we haul' concept is quite archaic, or at least should be for any professional ambulance service. 

Speaking about my own service, we give advice to pt's based on what's best for them. During normal office hours, there's limited urgent care services (i.e. non-appointment walkins) which are mainly open in the evenings and weekends but we'll regularly call a pt's own Dr to try and squeeze them in for an urgent appointment if practical..sometimes we transport, sometimes we don't. Other times pt's are happy to sit in the hospital waiting room..so be it.

 

25 minutes ago, Just Plain Ruff said:

how many services "CAN" transport to a urgent care center?  I don't know of any services in my area that are able to transport to urgent care facilities and I believe its high time that we begin to be able to.  

I also think that Urgent Care facilities are pushing back against this though. 

I find it a bit strange that urgent care facilities wouldn't want pt's. And I don't see how it matters if a someone comes via bus/car/taxi/ambulance/whatever unless there's something I'm missing

In regards to that paper, I think having a direct phone line for high risk pt's post discharge is a great idea. There are few general nurse run health advice lines that pt's regular use, however, if someone were to mention that they were recently discharged post CABG or whatever, the call would likely get transferred to the ambulance comms regardless. Some of the other processes seem to be good as well and are definitely long overdue

On a side note, a while ago I read an insightful paper written by an emergency consultant which basically stated that true emergency presentations in his department were overwhelmed by the non-acute..it was an interesting perspective...I'll see if I can dig it up.

 

[Arctickat]

46 minutes ago, Just Plain Ruff said:

What if the patient demands to be transported to an UC facility?  Can we refuse to transport them there?  If it's an appropriate facility then is it wrong.  

 

"Transport to the nearest APPROPRIATE medical facility"

If they can be treated at a UC, do they need to go to the ED even if it is nearer? I think our protocol is a cut and paste of almost every other protocol out there.

"Transport to the nearest APPROPRIATE medical facility, bearing in mind that the nearest appropriate facility may be more distant than others nearby"

People have interpreted that to mean that we are to bypass the local hospital in favour of more advanced care at a cath lab or a trauma centre, however, I look at it both ways. If my patient doesn't need the services of that Level I Trauma centre two blocks away...I'll take him to that UC ten blocks away.

I don't think it's a matter of "can we" Mike, but "Why don't we when we already have a protocol in place for it?"

Maybe, back in the day, transporting to a lower level of care wasn't the spirit of the protocol when it was first devised, but then, your founding fathers never considered the possibility of easy to conceal automatic weapons when they wrote the Second Amendment either.

 

[Just Plain Ruff]

This is great discussion. 

I know that in the services where I've worked, there was never any intention and if I tried to transport the patient to the doctors office or the urgent care facility i was met at the hospital (because I was forced to transport there) by my supervisor telling me "We just dont do it that way here" and I always slammed my head against the wall asking the question "why? tell me why do we transport to the ER when the Urgent care or this patients doctors office would work just fine"  They countered with "they called the ambulance so they go to the ER, and Mike, Just drop it" 

I would then counter well we go to the nursing home or a homebound patients house and pick them up, drive them to their doctors office for an appointment and then drive them home, what's the difference.  Again, told to drop it.  

I was told that insurance would never cover the emergency response to the house, and then a drop off at a doctors office or urgent care and the service would not get paid.  Again told to drop it.  

So finally I did.  And many times, the service didn't get paid even by going to the ED.  

So I kind of laugh inside.  

[paramedicmike]

At least here in the States it would require a hefty paradigm shift in order for this to happen.  Insurance would have to get on board.  Doctor's offices and urgent care centers would have to get on board.  There would have to be a change in the education of those staffing the ambulances to safely make the determination of where best to take the patient.

Not saying it couldn't happen.  Not saying it won't happen.  It's just gonna take a while to get there.

[Just Plain Ruff]

17 hours ago, paramedicmike said:

At least here in the States it would require a hefty paradigm shift in order for this to happen.  Insurance would have to get on board.  Doctor's offices and urgent care centers would have to get on board.  There would have to be a change in the education of those staffing the ambulances to safely make the determination of where best to take the patient.

Not saying it couldn't happen.  Not saying it won't happen.  It's just gonna take a while to get there.

Exactly my friend.  that's why I was told to drop it.  they knew they weren't going to get paid so they squashed it.  

Patients didn't know any better so they didn't push it.  

but every once in a while a patient would ask the question "Can't you just take me to my doctors office"

Big paradigm shift, but I can see it happening.  Not in my EMS lifetime, but maybe my son's if he decides to get into this line of work.  

[Just Plain Ruff]

By the way, I hate being told no.  Being told that "it's the way it's always been done"

[paramedicmike]

The six most dangerous words in the English language: "We've always done it that way."