How Fort Worth’s ambulance service, MedStar, brings the ER to you

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West of Six Flags and a few miles off of I-30, community paramedic Kyle Barbour swings a heavy bag of medical supplies onto his shoulders and knocks on his third front door of the day. It is a little house in a row of little ‘60s-era houses, and a retired DART bus with splintered windows rests on the front lawn.

“I call him Mr. O,” Kyle says just before the door opens. It’s dark inside, light glowing from just one of the four overhead lights and the TV where daytime television—a game show—plays silently. Mr. O sits in a nearby easy chair. He speaks broken English and his wife passes through now and then with her cane and her dog.

Kyle sets his Surface Tablet on the bed where he can reach it and kneels down beside him. “Hey, Mr. O, how are you feeling today?” he asks brightly and begins to take his blood pressure. The questions keep coming. “How’s your breathing? How’s your walking? You’ve been taking your medication?”

Mr. O was released from the hospital recently; in fact, this is only Kyle’s second home visit to check up on him. He’s homebound in house slippers, though Kyle suggests he spend some time on the porch. It’s a beautiful early-spring day in Fort Worth.

During their conversation, a mix of small talk and medical jargon, Mr. O lets on that he doesn’t have four of the medications he needs, nor does he have transportation to go to the pharmacy. The physical evaluation is over, but Kyle’s work has just begun.

Over the course of three phone calls and an hour, Kyle calls a clinic to discuss funding and Mr. O’s social worker to discuss how he can get his medication.

“Here’s what I’m going to do,” Kyle says eventually, handing him an application to fill out for a program which offers free rides to the pharmacy and doctor’s appointments for those who can’t get there on their own. “I’m here to help. However I can. Fill this out and I’ll do the rest.”

Kyle originally trained to be a paramedic on a fire truck. But the ER, as he puts it, grabbed him. After 10 years as a paramedic, Kyle now spends his days driving around greater Fort Worth attending to patients in their own homes. It’s all part of Fort Worth MedStar’s Mobile Healthcare Unit.

“We’re here to keep you from falling through the gaps, wherever the gaps are,” Kyle says as he drives to the next patient’s house. “We’re trying to keep people out of the hospital.”

Fort Worth’s MedStar fields 400 calls in one day and ferries an average of 90,000 people to area ERs each year. In 2008, their data revealed that they had transported the same 21 individual patients to area ERs more than 2,000 times, resulting in $962,429 in ambulance charges alone. They realized that it must be due to a high number of “ER abusers,” or people who call emergency services up to 15 times in a 90-day period, often for issues that are not emergencies. It was baffling, but also a strain on time and resources for the patient, MedStar and the hospital staff, especially considering that hospitals all over the country are struggling with staffing issues and the worldwide shortage of nurses, reported by the International Council of Nurses in 2004, still persists. Worse, hospitals are also penalized by the government for readmissions.

So in 2009, Fort Worth’s ambulance service, MedStar, began to send community paramedics like Kyle on home visits.

“They can be taken on this program to see why they call so much,” Kyle explains. “Sometimes it’s because there’s an untreated recurring issue, sometimes it’s hypochondria, a misdiagnosis, maybe they don’t know what else to do, or maybe there’s a psychological thing going on.”

“You can talk to patients in the ER, but if you get someone in their home and sit down and talk to them, they listen better, we listen better…communication is a lot better,” Kyle summarizes. “We do labwork. We can look at their electrolytes, kidney function, we do all that and with Congestive Heart Failure (CHF) patients we can make sure their kidneys are okay…It’s almost like how doctors used to do house visits. We’re usually on the phone with someone and we communicate with their primary care doctors.”

The program has expanded beyond system abusers. Often, through partnerships with hospitals and JPS Health Network, patients who are deemed at risk for readmission in 30 days or less, are referred to MedStar for care that not only prevents them from returning to the ER but often saves their lives.

Most of Kyle’s patients are around 40 to 60 years old, earning a low income and without insurance. He’s been able to prevent his patients from taking too many pills or getting their dosages mixed up once they’re released from the hospital. “Doctors feel more comfortable sending patients home if they know there’s someone who can go out there and check on them,” Kyle explains. “Some doctors are right there with us and love us; others don’t know who we are yet.”

The idea is catching on like wildfire. Medical students and hospital representatives from all over the world have visited Fort Worth to observe the program. In Plano, there is a similar process where local EMS staff workers coordinate with certain hospitals to follow up on patients who have recently been released.

After working with Mr. O’s caseworker to ensure he gets the Meals on Wheels he needs, Kyle makes an extra stop before his next patient to pick up his prescription, which will be paid for through a nonprofit.

“For some people, this is their social time. You can hold them accountable and take care of them and they bond with you. People need that. Sometimes they don’t have family around,” he says.  

His next patient is an older lady who has grandchildren running around, crosses on the wall and a movie starring Ben Affleck on in the background.

Kyle starts all over again, sitting on the couch with her, organizing her pill minder for her and advising her to get outside, take a little walk if she’s up to it.

“You’re a perfect client,” he says with a smile. “Let’s get your vitals.”