Milwaukee VA Medical Center
Partnership with West Allis FD helps Veterans
What’s better than getting treated in a hospital’s emergency department?
Not having to go there in the first place.
And that’s the goal behind an innovative partnership forged between the Milwaukee VA Medical Center and the West Allis Fire Department.
The Mobile Integrated Healthcare program seeks to find out why some Veterans make numerous trips to the ED and then figure out ways for the Veterans to better manage their health.
It starts with a team of specially trained paramedics who make house calls to Veterans known to make frequent visits to the ED.
These aren’t emergency lights-and-sirens calls; instead the paramedics are working proactively. They talk with the Veterans about their medications, check out their surroundings and make sure they are in contact with the right resources.
“We get eyes on them in their house, in their environment, to see what issues they have that can be mitigated,” said Capt. Armando Suarez Del Real, MIH program coordinator for the West Allis Fire Department. “If they are utilizing the ED a lot, chances are they are not complying with some area of their care plan.”
“They find things that we can’t see here in the ED,” said Ann Baggett, social worker for the Milwaukee VA Emergency Department. “It helps us a lot.”
“The goal is to decrease unnecessary ED visits at the VA and increase appropriate outpatient visits to the VA. This is a great program to help set up that care coordination and make sure Veterans are getting to the right place.” Ben Thelen, ED program manager
“The goal is to decrease unnecessary ED visits at the VA and increase appropriate outpatient visits to the VA,” said Ben Thelen, Emergency Department nurse manager. “This is a great program to help set up that care coordination and make sure Veterans are getting to the right place.”
Thelen noted the visits go beyond health checks to include outside circumstances that may lead to adverse health effects, such as hoarding, falling hazards, lack of smoke detectors, etc.
“We don’t always hear that when the Veterans comes to the ED,” he said. “But maybe that’s why they’re coming here – because the home’s not safe.”
First in the nation
The program was piloted a few years ago, involving other area hospitals, not just the Milwaukee VA. In August, the contract between the Milwaukee VA and West Allis was approved.
“This is a first-in-the-nation relationship between VA and fire departments,” Thelen said.
Wes Allis is the first fire department in the state to have an MIH program, said Suarez Del Real.
“It’s not the norm, but in our opinion, this is the future of EMS,” he said. “It’s a very proactive approach to EMS. We’re trying to reduce the inherent risks that are involved in most people’s lives.
“From the fire department’s standpoint, rather than being reactive and responding when someone calls 911, we’re trying to identify those needs that will prevent you from having to call 911.”
Finding, solving problems
While piloting the program, paramedics discovered a host of problems that were putting residents’ lives in danger. Thelen remembered during one visit, paramedics found a hypotensive man living in a home with a hole in the roof. In addition, he was taking four times the amount of medicine than he was prescribed.
“These are things we didn’t know about in the ED,” he said. “He would just show up hypotensive and we wouldn’t know why.”
Jason Schaak, assistant chief, community risk reduction division, for the West Allis Fire Department, said medication errors were the most frequent problems discovered during the pilot program.
“The patients thought they were taking the medications appropriately, and they were reporting to their physicians that they were taking it appropriately, but after sitting down with them and going through it one-on-one, (that wasn’t the case),” he said. “So we had to educate the patient.”
Suarez Del Real also noted that some patients are so uncomfortable or anxious when they are in the hospital that they will say and do anything just to go home.
“They tell them (doctors) what they think they want to hear because they want to get out of the hospital as quickly as they can,” he said.
And that leads to patients not following up with appointments with specialists or social workers, or not following through with their health care plans.
But the home visits often produce a different story.
“They’re a little more comfortable in their environment, where we can sift through the issues and get to the bottom of why they can’t comply with their care plans,” Suarez Del Real said.
Thelen noted that patients involved in the program are “complex, high-risk patients” with “medical, mental and social illnesses.”
Once problems are discovered, the paramedics help the patients find solutions, which could involve working with a social worker, patient advocate or someone in the community.
“A lot of time they just don’t know what resources exist,” Schaak said, noting that navigating the health care system can be daunting for many patients.
“It used to be you would come in and speak to somebody in person. But now you’ve got 12 different phone trees that lead to six different services,” he said. “And your doctor may refer you to some other specialty you can barely pronounce, let alone know what they do. You have to be really engaged with health care today in order to thrive within it.”
Thelen said response to the program has been positive.
“The Veterans love it,” he said. “They all said, ‘I wish this would have been here 10 years ago when all these problems started.’”
Schaak admitted that the program is so innovative that it took some members of the fire department awhile to warm to it. Plus, specialized training is needed for the paramedics involved.
But after the program was piloted, it wasn’t long until ED calls started to drop.
“I think some folks were reluctant to take up that change, but over time they see the impact and they see the residents we would typically go to two or three times a week now thriving within the community,” Schaak said. “It’s not for everybody, but it’s certainly proven its worth.”
Thelen said the Milwaukee VA chose to partner with West Allis not only because of the high number of Veterans who live there – the most in Milwaukee County outside of the city of Milwaukee – but also due to its reputation for embracing innovation.
“I think of all the agencies we work with, they are the most progressive in buying into this concept,” Thelen said, noting that West Allis MIH teams can travel to other municipalities as well.
“We have a deep appreciation for our Veteran population,” Schaak said. “Partnering with the VA is a natural step for us.”
“This is a very unique program,” Suarez Del Real said. “We’re looking forward to the future and not settling for the way things have been. We’re moving forward.”