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Are You Ready for Your Next MIH Visit?

What do you bring into the house on a typical 911 call?  Maybe your computer, a cardiac monitor, a radio, a cot and a few overstuffed bags. But for Community Paramedicine and Mobile Integrated Healthcare (CP-MIH), when you start making house calls to follow up on patient referrals, your mindset needs to shift to fit the situation.  Let’s get into the details of how our clinical, operational and documentation priorities change moving into CP-MIH.

Clinically speaking, what you’ll need to bring depends on what your program does. Will you need a set of vitals on all patients?  Will you be doing mother infant visits?  Some programs partner with local healthcare systems which require specialized assessments and non-standard equipment. For example, they might ask the paramedic to draw labs during an appointment, or use a scale to check a CHF patient’s weight.

What you’ll need to bring also depends on who is involved. Will you send out a paramedic or a social worker? Will they work solo or with a team? Keep in mind that one paramedic can only carry so many things with them into a house.

How will you document the encounter? If you use a Toughbook to document a 911 call, will that still be appropriate for a follow up visit, or would an iPad work better?  If you’re planning to include telehealth in the visit, what device will you use for it? Will you need a wireless hotspot?  Or, if you’ll be bringing a stack of paper forms, will you need a clipboard? (In the early days, there were many times when I dropped a whole stack of loose papers; what a mess!)

These tips are provided by Mindy Gabriel, a 20-year paramedic with extensive experience in successfully designing and launching Community Paramedicine and Mobile Integrated Healthcare (CP-MIH) programs.
Prior to joining HealthCall, Mindy served as the Deputy Chief of EMS Operations for a midwest fire department.

On the software side, if you plan to use your 911 EHR platform to document, does it have a way to record this kind of work? You may need a more longitudinal way to documenting patient care, unlike the episodic way 911 calls are documented.  What assessments are you planning to do on each visit, and what assessments should you have ready to do as needed? How will you share this documentation with the patient’s care team, or for CQI initiatives?

Operationally, will you need to mark on the radio that you are on scene?  Will a MIH visit be counted as a run, with a number assigned through dispatch?  Is everyone familiar with these tools and procedures – even non-traditional providers like social workers?  After the visit, do you have promotional material to leave behind with the patient? Consider whether magnets or stickers, which are hard to lose and can be displayed prominently, would be a good fit for your material.

Establishing a safety plan makes good sense when you are starting out on a new endeavor.  How will you look up safety concerns for a patient? Have you established a procedure to use if a follow up visit becomes unsafe? It’s also good to consider the neighborhood. What vehicle will you drive, and how will you explain to neighbors why your vehicle is parked outside the house?  Then there are comfort concerns – if you are in a house for an hour doing an intake, and there is no available seating, will you just stand for the whole visit?
(Pro tip: I bring in a camping chair.)

Starting MIH work is like going to your first day of school – plan ahead for a great first house call! Spend some time writing out a list of what you need, and you will see where it differs from your standard 911 equipment. And be flexible, since your equipment needs will continue to change along with your program.  Best of luck!