Situation: Problem Area and Proposal
Many patients under hospice programs often prefer to stay at home rather than be hospitalized; therefore they require the services of home visiting nurses. Most often while on the road for a home visit a nurse might receive a call from triage nurses to change direction and visit someone who needs emergency services. Emergencies such as troubled breathing, profuse bleeding or a patient running out of medication might require immediate medical attention. While the triage nurse might help through the phone, the home visit nurse needs to be around. Most of these patients need to be transported to an intensive care unit facility while others can be helped at home. Unfortunately traffic rules of high-occupancy vehicle lanes do not allow nurses to get to the patient in need. The proposal would be to pass a law that allows home care nurses on duty to hake the high occupancy lanes and have sign lights on their cars just like fire department volunteers have so they can attend to emergencies efficiently. The fact that most people increasingly require home treatment should invigorate the need to allow nurses to use the high occupancy vehicle (HOV) lanes for emergency cases.
Background
There have been many incidences where families lost patients due to delayed care. There was an occasion when I was visiting a patient for regular checkup but then had a call from the triage nurse informing me that there was an 86 year old lung cancer patient reported to have serious breathing problems. The freeway was not moving, I was stuck on traffic jam for about an hour when I decided to use the HOV lane. The police pulled me over and I received a ticket. It is unfortunate that when I got to my destination the patient had already passed. A high occupancy vehicle is usually located close to unrestricted lanes von the left. The HOV lane has distinct markings and is reserved for certain vehicles. The HOV provides a number of benefits for its users but the most significant is decrease in travel time for drivers on the lane. Other benefits include positive environmental impacts and utilization of existing infrastructure. In Northern California, HOV lanes are only operational on weekdays at designated peak hours and other vehicles might use the lanes during off-peak hours. In Southern California HOV lanes are separated by a buffer zone; they are operational full-time. The schedules differ between the two regions due to commuter patterns and traffic volumes. According to California state law, the aim of the HOV lane is to reduce congestion and improve air quality. California state law exempts hybrid and clean fuel vehicles from the occupancy requirement. The California Highway Patrol is responsible for HOV enforcement with violations carrying a minimum of $490 in fines. I spoke to my colleagues and friends about this issues and they verbally agreed that many would benefit from the idea. According to a New England Journal of Medicine, about one in five beneficiaries of Medicare is readmitted after hospital release. That translates to a $17.4 billion in Medicare on patients whose return trips could be avoided. The hospice care role aims at reducing hospital readmissions in home care settings. While education of family plays a significant role in patient care management creating legislation that allows nurses on duty to use HOV lanes and utilize lights on their cars as a means of communication on the road to assure quality of care and faster arrival. The “move over” bill recently passed in the State of New York was meant to protect law enforcement officers and utility workers however it failed to protect ambulance operators and volunteer firefighters. However the legislation was updated with firefighters permitted to use blue lights and ambulance operators assigned green lights. It is unfortunate that most states have not passed legislation to ensure that home care nurses are allowed to use HOV lanes and assigned lights to communicate with other drivers. Nurses are the first responders for emergencies that occur in home care settings.
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Assessment: Finances and Stakeholders
The idea would create significant financial gain through the reduction of hospitalization rates and consequently Medicare costs. The implementation of the idea will ensure that the quality of healthcare is high in home care settings. The lights could cost a slight amount of money when buying for the first time but its efficiency could be improved through reusing incase the nurses change the workplace. Additionally it is an inexpensive feature that can be added in any car model. Ensuring that nurses are not rushing to respond to emergencies on busy lanes ensures their safety on the roads. Some of the stakeholder groups that could support the bill include community members and families that rely on home care. Home care agencies could be involved in the research with the intention to enhance quality of care and provide feedback surveys. Hospitals that aim to reduce readmission percentages are other stakeholders anticipated to support the bill. I do not anticipate any opposition to the bill. Healthcare providers such as medical doctors, nursing practitioners, and registered nurses is a group of stakeholders that can be rallied to support the bill.
Recommendation
I propose a meeting with the California State representative to discuss the details of the proposal and how it would improve the lives of nurses, patients and their families.
References
Avoidable Hospital Readmissions: The Role of Hospice and Palliative Care Providers. (2013). Retrieved from https://www.crossroadshospice.com/healthcare-professionals-resources/palliative-care-blog/2013/october/24/avoidable-hospital-readmissions-the-role-of-hospice-and-palliative-care-providers/
Bakker, M., Creemers, H., Schipper, K., Beelen, A., Grupstra, H., Nollet, F., & Abma, T. (2015). Need and value of case management in multidisciplinary ALS care: a qualitative study on the perspectives of patients, spousal caregivers and professionals. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration , 16 (3-4), 180-186.
Ingoglia, D. (2016). Change in the NY Move Over Law Benefits First Responders. Retrieved from https://www.ultrabrightlightz.com/ultra-bright-blog/change-in-the-ny-move-over-law-benefits-first-responders/
