CHALLENGE AND EXECUTIVE SUMMARY
The opioid crisis is a population health issue impacting lives in nearly every community across the country. Emergency Medical Services (EMS) and public safety first responders are on the front line of treating these overdose patients. The initial lifesaving acute care they provide is but one step in the continuum of time-sensitive care that includes hospitals, recovery specialists and ongoing treatment programs necessary to prevent the vicious reoccurrence cycle.
Through the use of a specialized digital mobile telemedicine app, EMS is uniquely positioned to save lives through timely intervention with opioid antagonist drugs while engaging the hospital, registries and recovery specialists to initiate broader acute care workflow improvements. Multi-faceted alerts including data collected and shared real-time with providers, speeds treatment and engagement to improve outcomes and long-term patient recovery. Collected data is also aggregated and available to organizational and governmental entities for reporting, benchmarking improvements and trend-analysis.
The following Opioid Overdose case workflow process is based on the e-Bridge Workflow Mobile Telemedicine app provided by GD (General Devices). The solution provides an easy to use, state or region-wide mechanism to alert, notify and track all opiate/opioid overdose patients in real time from prehospital first medical contact through hospital emergency department, to recovery specialist, caseworker and recovery program.
Overdose Workflow: (refer to flowchart)
Note: This is an example workflow. All e-Bridge Workflow templates are highly configurable, allowing flexibility to operate protocols your way, ensuring maximum effectiveness and compliance.
- 911 communications center receives a call for a possible overdose and dispatches EMS.
- EMS receives the CAD location information and responds. Dispatch and arrival times documented in CAD. Upon arrival, EMS’ patient assessment identifies possible opioid overdose.
- EMS clicks the “Overdose” button of the e-Bridge app on their mobile device and treats the patient. The location is tagged and the running time clock begins 1.
- The highly configurable workflow template prompts for initial patient demographic 2, driver’s license, ID scan/pic, and medical incident and treatment information.
- The base station or destination hospital is selected for medical direction and notification is sent – alerting the hospital team.
- Notifications for events such as Naloxone administered, are time stamped, logged and shared in real-time with preselected team members via e-Bridge app (ED computer, mobile devices, etc).
- Existing or newly assigned recovery specialists or agencies can be notified and added to the team either preconfigured or at any point by ED staff after arrival.
- Patient/Case/Event can be added to the Overdose Registry either at this point or by ED staff after arrival.
- Live (synchronous) or asynchronous video consult with physician, recovery coach, etc is available. Secure multi-media such as pictures, video, audio, text, team chat, and vital sign and ECG sharing is available.
- If transporting, live ETA sent to receiving hospital, registry and recovery specialist once en route.
- If AMA refusal, video consult with physician or recovery specialist may avert refusal, otherwise video documentation of refusal is recorded to mitigate risk.
- Hospital ED physician/nurse notify/add hospital patient registration to the case, allowing them to pre-register the patient before arrival.
- ED team member assigns bed and EMS is notified pre-arrival via the app.
- Hospital ED can see tracking map with priority and live ETA. Once the ambulance is within “geofence” of the hospital an “Arrival” alert is announced and displayed and team members are alerted on the e-Bridge app.
- EMS arrives and moves the patient to the pre-assigned bed and hands off the patient to the ED staff that is already prepared and ready with a pre-registered ID wristband.
- ED staff take over patient care and the pre-hospital phase of the case is ended.
- EMS clears up from the call and goes back in service but is available for questions, team chat, notifications and outcome results via the e-Bridge app.
- Downstream outcome feedback/status is entered by hospital staff, EMS is notified via e-Bridge.
- The Recovery phase of the case begins 3
- The patient is set up with the e-Bridge app and provided a secure login and instruction before discharge from the hospital.
- Recovery coach/specialists communicate securely with the patient via e-Bridge app. Family, peers, physicians are invited to participate in group communications aimed at long-term support and recovery.
- Reports and data are provided to the appropriate agencies.
- Education, checklists and information can be provided to the patient and their support network via e-Bridge 3.
Notes (for optional solution add-ons):
- Automatically pull dispatch info from CAD database.
- Automatically pull pre-existing patient info from the database, alert providers of prior events, coaching contacts, etc.
- Recovery phase/case to be developed/partner and configure to meet state/local operational requirements.
- 1-click EMS & ED initiated real-time tracking of care for overdose patients
- Early alerting of parallel and downstream resources (recovery & registry)
- Early engagement and follow-up for patients that refuse AMA
- Data and reporting for local, state and national
- Outcome feedback data for EMS and all care teams
- Force multiplier with other acute-care workflows (Stroke, STEMI, Trauma, Sepsis)
- Improved outcomes and sustained recovery
- Real-time view of care workflow
- Early warning system