O1021: Novel Home-Based Community Paramedic Program for ED Patients Discharged on Oxygen: Bridging Gaps in Transitional Care

Background: Prior studies have demonstrated that home oxygen therapy for pediatric patients with bronchiolitis discharged from the emergency department (ED) is both safe and cost-effective. However, ensuring adequate follow-up and monitoring remains a challenge, particularly for families facing barriers to timely outpatient care. To address these barriers, we partnered with Albuquerque Fire and Rescue to implement a home-based community paramedic program. This initiative aimed to provide in-home follow-up and re-evaluation for low-risk pediatric patients discharged on oxygen for bronchiolitis, ensuring appropriate management while addressing additional social needs.

Methods: During the 2023-2024 respiratory season, pediatric patients discharged on home oxygen for bronchiolitis from the ED were eligible for enrollment. Patients were considered low risk based on existing home oxygen protocols for bronchiolitis. To standardize assessments, we developed a novel bronchiolitis scoring tool (Fig. 1) and implemented a HIPAA-compliant referral system (Fig. 2) for use by community paramedics. Within 24-48 hours post-discharge, community paramedics conducted home visits to assess respiratory status, oxygen needs, overall clinical stability, and whether the patient required re-evaluation in the ED. Patient charts were reviewed for up to seven days post-discharge to determine whether the patient followed up with a pediatrician, returned to the PED, or required hospital admission. Program outcomes were compared to historical data from 2017-2021, during which time the home oxygen protocols were in place but the community paramedic program had not yet been initiated.

Results: In the program’s first year, 34 children were discharged on home oxygen, with most receiving community paramedic follow-up. This represents a substantial increase in ED discharges with home oxygen compared to the previous five-year period, during which a total of 36 children were discharged on oxygen. During the study period, only one child required subsequent hospital admission due to illness progression, highlighting the program’s safety and effectiveness. Additionally, community paramedics identified unmet social needs, including food insecurity and car seat safety, reinforcing the program’s impact on overall family well-being. The initiative is estimated to have prevented 1,728 inpatient hospital-bed hours and saved over $100,000 in direct hospital costs, excluding indirect financial burdens such as missed work and transportation expenses.

Conclusion: A home-based community paramedic program for low-risk pediatric patients discharged on oxygen for bronchiolitis is a feasible and cost-effective intervention that optimizes transitional care while maintaining patient safety. By integrating a standardized bronchiolitis scoring tool and a HIPAA-compliant referral system, the program facilitates efficient coordination and assessment. This project demonstrates the potential for community-based healthcare models to improve pediatric outcomes and reduce hospital resource utilization. Future efforts should focus on expanding availability and evaluating long-term impacts on healthcare access and cost savings.