When a 90-year-old woman was discharged recently from Methodist Hospital after a bout with bronchitis and respiratory issues, some visitors dropped by her Minnetonka home the next day.
They were firefighters.
But they weren’t there for an emergency. They took her blood pressure, talked about the new medicines she was on and made sure she knew how to use her inhalers. They checked to see if her smoke detectors were working and whether there were any rugs she might slip on.
It was a trial run for a pilot project that begins in May, pairing the Park Nicollet hospital in St. Louis Park with fire departments in that city, Edina, Minneapolis, Richfield, Eden Prairie, Minnetonka and Hopkins to help discharged patients make a safe transition from hospital to home. Edina’s Fairview Southdale Hospital is discussing a similar program with the Edina Fire Department.
In the hubbub of leaving the hospital, patients often don’t fully understand discharge instructions. At the hospital, they may be in pain, drugged and overwhelmed. Eager to get home, people say they understand what they’re supposed to do after they leave the hospital.
Then they don’t fill their prescriptions. Discharge papers sit unread. If they have their medications, they may be confused about what to take when.
If patients consent, the pilot project will send a firefighter to their home the day after they’re discharged to make sure everything is all right. The goal is not to duplicate services like home health nurses who visit later, but to handle immediate problems after discharge.
“It’s great to have firefighters do this, because they are such a trusted member of the communities,” said Linda Bauermeister, Park Nicollet’s director of nursing and population health.
Although Park Nicollet said its program is not linked to changes in federal law, some hospitals are devising what they call “readmission reduction programs” in response to the Affordable Care Act. Studies show that 20 percent of Medicare patients are readmitted to the hospital within a month of discharge. Now, hospitals may see their Medicare reimbursements cut if Medicare patients with specified ailments land back in the hospital for the same reason within 30 days.
Firefighters ‘fill a gap’
Each day, Methodist discharges an average of 49 people who go home. Patti Betlach, director of palliative medicine and community care, said she did not have data on how many quickly return to Methodist. Among the patients who are the most vulnerable or who need therapy at home, she said, about 55 people a year come back to the hospital in the few days after they are discharged.
Planning for the Methodist program began after Park Nicollet officials were approached by St. Louis Park Fire Chief Steve Koering. With health care rapidly changing even as his department remains responsible for responding to 911 calls, Koering said, “the last thing we want is the Fire Department on the outside looking in.”
“We can fill a gap here and say, ‘Did you understand? Let’s take a look at your prescription.’ We’re there to bring some calm and answer questions,” he said. “We can make people feel more secure in their home.”
The program, called the post-discharge firefighter visit, also adds to the health care duties of fire departments that have fewer fires to fight. Most of their 911 calls are now medical.
That’s expensive. When someone in St. Louis Park calls 911 with a medical need, the Fire Department sends a fire truck and Hennepin County Medical Center sends an ambulance.
Some calls come from people who are just out of the hospital. “They’re unsure, or lonely, scared and confused, and the ambulance comes out,” Koering said. “If somebody could come out [the first day after discharge] and see them and see what they need, it would make them feel safer in their house.”
Hopkins Fire Chief Dale Specken said his department, too, gets 911 calls from people fresh from the hospital. Sometimes symptoms have worsened or people have forgotten to take or get their medications. With no medical background on the caller, responders have little choice but to take people back to the hospital.
“That’s not to say these calls aren’t serious,” Specken said. “They are serious to the person who’s calling. But [with the new program], we may not have them going back to the hospital.”
In mid-March, Methodist ran three post-discharge test visits with two firefighters from St. Louis Park and Minneapolis along with observers from Park Nicollet. In addition to the 90-year-old woman, firefighters visited a young woman who had undergone surgery and a 76-year-old man with severe heart failure.
The younger woman was low-risk but grateful for the visit, said Betlach. The older woman was concerned about how she was going to get to the doctor and the grocery store. Betlach said a list of community resources would be collected to help firefighters answer such questions.
The man with heart issues said what he found most helpful was firefighters clarifying a question about medications.
After people agree to a visit, firefighters get background information to guide their talk with the patient. They also check smoke detectors and carbon-monoxide detectors, install them if they’re missing, and look for hazards like slippery rugs or wires that cross floors. “The firefighters were extremely welcome into all three homes,” said Betlach. “The firefighters also were very comfortable.”
At the Legislature, a bill has been introduced that would establish certification for community emergency medical technicians who would work with patients in the 72 hours after hospital discharge. It also would allow state reimbursement for those services under Medicaid.
“This would help smooth the way to create more programs like Park Nicollet is exploring,” said Chris Parsons, president of Minnesota Professional Fire Fighters. “We think more hospitals will be interested.”
In the Park Nicollet project, firefighters would get training before making their visits.
The issue of reimbursement for fire departments hasn’t been settled. Edina Fire Chief Tom Schmitz said he has heard from departments in other states that rates range from $50 to $100 per visit.
“If we keep the patient out of the hospital for 30 days, it’s win-win,” Schmitz said.
He’s not worried that a decline in 911 calls would hurt the department.
“We always tell people to call 911 no matter what the problem is if they need to,” he said. “I think over many years, we’ve seen a slight decline. But there are still car crashes and people still get injured and sick. Fire departments have plenty to do.”