Children’s hospitals are accustomed to caring for children with medical complexity. The same may not be true for pre-hospital providers who don’t routinely care for complex pediatric patients.
That’s the impetus behind Project Austin, a Children's Nebraska program that provides children with medical complexity continuity of care in their home communities. Project Austin creates an emergency medical plan for each child in the program and trains local Emergency Medical Services (EMS) and emergency departments to care for the child’s specific needs.
Goals include helping EMS responders feel more confident providing care while also decreasing the risk of delayed treatment, unnecessary tests, and even serious preventable errors. Nationally, less than 10% of EMS calls involve pediatric patients and less than 1% of those involve a medically complex patient.
Rooted in tragedy
The program was co-founded by Tiffany Simon, MSN, RN, CCRN, whose 15-month-old son, Austin, developed a blockage in his tracheostomy. She called 911 for help, but with minimal knowledge of Austin’s needs, the EMTs tried to ventilate him through bag-mask-ventilation. Austin was eventually transported to a hospital where he passed away.
“The EMS responders were scared to death,” said Simon, who now manages Project Austin at Children’s Nebraska. “They were doing their best, but they weren’t trained on how to stabilize a child with special medical needs.”
Simon worked with fellow Children’s Nebraska nurse, Natalie McCawley, MSN, RN, CCRN, to found Project Austin in 2015. Since that time, enrollment has grown to include 2,200 patients, 500 local EMS departments, and 200 community EDs.
Individualized plans
Project Austin’s nurse case manager enrolls patients and works with their specialty physicians to create individualized emergency medical plans.
“Our emergency medical plans include everything from the diagnosis to the child’s baseline assessment along with treatment considerations that would be implemented should that child have a medical emergency. What works for 99.9% of the population may actually be a risk of harm for some of these patients,” Simon said.
The nurse case manager shares the emergency plan with the program’s outreach liaison who assesses resources in the child’s community and arranges a meeting with the child’s family and local EMS and ED staff.
“We humanize the child with medical complexities so they aren’t defined by a diagnosis. If we can bring them all together when the child is at their best, they see them as a child and that's not so intimidating,” McCawley said.
Familiarity helps EMS and local ED staff feel more confident during an emergency response. “We do that education together with the child and those two systems so they learn to become a community together. We’re trying to take the meaning of a health care team and expand it beyond the four walls of our hospital to include that child's local community,” Simon said.
Project Austin liaisons are identified within community EDs to support effective communication, and code words are used to help even young children call for help. A parent or sibling simply provides the code word to an EMS dispatcher to set the plan into action.
Changing technology
For most of Project Austin’s history, emergency plans have been printed on paper. Copies were kept in places where the child spent time: home, school, daycare, grandparents’ homes. However, it was difficult to ensure all the versions were updated if changes were required. Children’s Nebraska is now using a mobile app to store emergency medical plans. Emergency medical technicians simply scan a QR code for access.
“Kids change all the time, and they go to a lot of places. The electronic format helps with version control so it will always be the most up to date,” McCawley said.
Reduced ED visits and costs
The program has also resulted in fewer unnecessary emergency department visits, shorter hospital lengths of stay, and lower overall costs. Children’s Nebraska has shown a $221.6 million reduction in costs after implementing Project Austin nine years ago.
By providing community EDs and EMS services with exact instructions for a child’s care, the Children’s Nebraska team says fewer “double transfers” occur.
“We saw a decrease in transfers from community hospitals to Children’s Nebraska. And we saw a decrease in length of stay and in cost of care because they're getting the right care quicker and faster which decreases the length of stay,” Simon said.
Patients, EMS providers, and community hospitals receive Project Austin services for free. Children’s Nebraska supports the program financially; grants and value-based contracts offset operating costs.
Recognition and expansion
Project Austin received the 2023 American Nurses Credentialing Center Magnet Prize Award. Children’s Nebraska is using the prize money to expand the program beyond its service area and track outcomes on a national level.
“We want to standardize the case management model and redefine what a healthcare team is by including our community EMS partners and EDs,” Simon said.
A national database allows children’s hospital to track benchmarking data and learn from each other.
“We've been doing this for nine years, and we have a lot of live-and-learns to share. Our data has proven what we're doing is really working. We're making a huge impact on cost reduction in a Medicaid system at a time when payor mix really matters for the sustainability of hospitals,” McCawley said.
Learn how to implement Project Austin at your hospital.
