The Mobile Emergency Team for the Elderly
Last week, I traveled to Uppsala from Stockholm to meet the team of the Mobile Emergency Team for the Elderly (Mobile Team). I am in the process of writing an in depth case study of the Mobile Team. This case study is part of our larger effort to identify good practice in integrated eldercare in a number of countries, including Sweden, Singapore, and the United States.
The Mobile Team is a leading example of integrated eldercare. Healthcare professionals can learn from the organization in general, and from its philosophy. As I build this case study, I will share with you some of my experiences with the process and what I am learning. In a series of blog posts, I will tell you about the Mobile Team and highlight different aspects of their work.
The Mobile Team started as a project in 2011, with financial support from the Swedish Association of Local Authorities and Regions. Today, the Mobile Team is financed by Uppsala Municipality and the Uppsala County Council. Uppsala County is located just north of Stockholm County. All members of the Mobile Team are employed by Uppsala County, which covers sixty percent of the total costs of the Mobile Team. Uppsala Municipality covers the remaining forty percent of the costs. Both the county and the municipality raises funds through taxation.
The Mobile Team becomes involved with patient care through several different avenues: Nurses who work in homecare organizations contact the Mobile Team when they need a second opinion on a patient. Employees at care homes for the elderly contact them for advice. And ambulatory personnel coordinate their efforts with the Mobile Team.
The Mobile Team centers on the needs of the patient. The objective of the Mobile Team is to offer urgent care at home to people over the age of sixty five. Many older patients visit emergency rooms at hospitals for urgent but non life threatening care that can be treated at home. Often, these patients must wait for hours at emergency rooms because their illnesses are not as pressing as the illnesses of other patients seeking emergency care.
The Mobile Team performs urgent care right in patients’ homes. The Mobile Team is able to measure glucose, take blood tests, test urine, and perform electrocardiograms in the home. The team can treat patients with a range of drugs at home. They measure blood flow in arteries to assess if the blood circulation provides enough blood to the legs and to the brain. Blood circulation to all tissue is necessary to avoid stroke, for example. The team also measures saturation, or oxygen levels in the blood.
They treat patients with pariboy, an inhaler, if patients experience difficulty breathing. The team also treats minor wounds. When a patient needs treatment at the hospital, the Mobile Team coordinates with the ambulatory service to arrange transport.
Many older patients need support at home from multiple caregivers. The Mobile Team coordinates care with these caregivers, including professional homecare providers. If a patient visits the emergency room for an illness that can be treated at home, a municipal nurse of the Mobile Team, who works at the hospital emergency room, informs the patient of the Mobile Team. If possible, the municipal nurse informs the patient caregivers of the treatment that the Mobile Team can offer at home. If a patient needs urgent care a second time, the caregivers and the patient know about the Mobile Team.
The Mobile Team includes a nurse from the municipality and a doctor from the county. Sometimes, the municipal nurse needs assistance from the doctor to treat patients at home. In turn, the doctor often relies on the expertise of the municipal nurse about the full care plan for a particular patient. For example, the municipal nurse coordinates the effort of the Mobile Team with the effort of homecare teams. The Mobile Team and homecare teams work together to ensure that patients obtain the support they need to stay at home and recover. Both the healthcare and the social care needs of the patient are assessed. Many times, doctors assess healthcare needs in isolation. Homecare teams assess social care needs. The Mobile Team can help provide for these needs by increasing communication between caregivers.
The quality of healthcare delivered to a patient depends to a large extent on the quality of communication between caregivers. This is particularly true for older patients with complex needs. The municipal nurse in the Mobile Team can update homecare providers on new treatment and new medications. Sometimes, the communication between doctors from the county and homecare providers can become delayed. Since the Mobile Team only recruits nurses with experience from municipal care organizations, the nurses in the Mobile Team are familiar with the channels of communication in the municipality. This familiarity speeds up communication and creates added value to patients that obtain care from different caregivers.
The Mobile Team is a critical link in the integrated healthcare chain in Uppsala Municipality. The neighboring municipalities are examining the possibility of establishing similar mobile teams.
The combination of the medical expertise of the doctor from the county and of the network and the experience of the municipal nurse renders the Mobile Team more effective than its constituent parts. Integrated care requires that different care providers collaborate. Different healthcare providers must acknowledge each other, and they must understand each others’ abilities and limitations.
Healthcare professionals cannot become experts in isolation. High quality healthcare at home and the timely transfer of information to homecare organizations improve patient experiences and patient outcomes. The best healthcare at home will not in itself prevent the patient from falling ill a second time. A patient may need help cooking or remembering to take her medication. If the homecare team is not informed or fails to help the patient take her medication, the patient may soon fall ill again. This is just one example of the interdependencies of integrated care models. Each care provider depends on other care providers. Patients depend on multiple care providers.
The Mobile Team collaborates with nursing homes, ambulatory nurses, the emergency service at Uppsala University Hospital, and various homecare organizations. Follow this blog for more information about how the Mobile Service works with other healthcare providers.