HJNO Jan/Feb 2022

HEALTHCARE JOURNAL OF NEW ORLEANS I  JAN / FEB 2022 13 Q & A What prompted the idea to use paramedics in the ED? We have been facing ongoing shortages of emergency department nurses, continu- ally utilizing costly agency nurses and over- time to fill open shifts. Was it COVID-related or in theworks before the pandemic? We began conducting due diligence across the state and region to glean best practices of where other facilities and health systems were utilizing paramedics. We obtained various policies, scopes of practices and conducted interviews with our counterparts. We discovered that the paramedic scope in the emergency depart- ment was vast, and they could be utilized in virtually any area of the ED due to their unique skill set. We received support from our medical staff and nursing leaders to begin integrating paramedics throughout our system, with our first paramedic start- ing in February 2020 — right before the first COVID surge. Was it primarily to address a short- age of nurses, orwere there particu- lar skillsets and experienceyouwere seeking from the medics? It was primarily to address nurse short- ages, but the skillset is ideal for the ED due to their training on identification of “sick” patients. In addition to the paramedics’abil- ity to identify sick upon arrival and provide expert triage, we recognize that the para- medics could also assist our physicians with the care of acutely sick or injured patients throughout the course of their ED visit. Hadyou seen it modeled elsewhere? Ochsner-LSU Shreveport had imple- mented paramedics in the ED prior to merg- ing with Ochsner. In addition, we met with our colleagues from local facilities in New Orleans and other health systems in the southern region. Howdid you get started? Our River Regions ED nursing direc- tor, Sandra Prather, is a former paramedic who “owned” the research and discussion of utilizing paramedics in the ED. Sandra was key to our workgroup in developing the scope of practice that would eventually be approved by our nursing and physician executive leaders. In addition to defining the scope of practice, we also had to create new access profiles for the paramedics within our electronic medical record to ensure the paramedics could document appropriately. When did the program start? Early 2020. Howmanyparamedics didyou start with? Three at Kenner ED. Are you still hiring? Yes, and throughout EDs in the system now. We have over 20 Paramedics through- out our system at Baton Rouge, OMC-New Orleans and Baptist. What additional training did you have to provide? Traditional onboarding to Ochsner and the ED workflow; ESI/triage education; annual competencies completed through Ochsner Flight Care specific to the para- medic scope of practice. What can’t paramedics do that an LPN or RN can? RNs can do initial assessments, and RN/ LPNs can do discharge education with patients — paramedics cannot do either. Howmanyparamedics are on a typi- cal ED team? The number of paramedics varies depending on how they are utilized, the volume of the facility and level of acuity of patients seen. They can assist in triage, sort through low acuity patients and support the treatment of higher acuity patients through- out the entire department. Howdo the paramedics/nurses feel about the program?What feedback have you gotten? It has improved over time as the ED teams have learned more and understand the scope of the paramedics. Overall, there has been positive feedback. What are the cost savings? What other upsides do you see? Paramedics onboard at lower rates than RNs but can’t completely replace RNs due to scope. They offer experience to the ED teams that are challenged with hiring expe- rienced RNs. Have there been any challenges? Access: getting the appropriate electronic medical record access, ordering access and pharmacy access. Our paramedic medical director presented to the EMS Board for approval of hospital medication adminis- tration. n with Ochsner Health Emergency Medicine Services Team