Presentation Title

False estimates of predicted low acuity complaints in the prehospital and Emergency environments

Start Date

November 2016

End Date

November 2016

Location

Watkins 2141

Type of Presentation

Oral Talk

Abstract

Objectives:This study compares the determination of appropriateness for Urgent Care (UCC) as assessed by retrospective chart evaluation to that of actual disposition recommendations made by practicing Alternate Destination Paramedics (ADPs).

Methods: In September 2015, as part of the State of California EMS Authority (EMSA) Community Paramedicine pilot project, the Orange County Fire Chiefs Association (OCFCA) initiated an Alternate Destination project. The project provided paramedics from participating departments additional training, and then permitted them to offer adult patients with specific low-acuity complaints transport to UCC instead of ED. Investigators collected baseline data to estimate potentially eligible pilot patients, using an evaluation protocol retrospectively applied to patient care records by research physicians. Instructors taught paramedic trainees to consider patients appropriate for UCC based on the protocol, with the added instruction to evaluate whether the patient would be able to return to the home environment after 3-4 hours of care at an UCC, based on chief complaint and functional status with their current injury/illness. The research team obtained preliminary aggregate data on eligible patients for comparison to the baseline period.

Results: In the seven-months baseline period, participating fire departments completed 11,814 patient transports; 737 patients (6.4%) presented with the included chief complaints and were deemed potentially appropriate for UCC evaluation by application of the study protocol. During the first 6 months of the program, 13,622 patients were transported. Using clinical judgment guided by protocol, trained ADPs designated only 84 patients appropriate for UCC (0.6%).

Conclusion: Trained paramedics using clinical judgment deemed few patients appropriate for UCC. In addition, more than 25% of patients deemed appropriate by paramedic judgment were contacted during time periods when alternatives to ED care were unavailable. It is likely that many previous studies estimating unnecessary EMS transports and ED visits significantly over-estimate frequency of inappropriate ED presentations.

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Nov 12th, 2:15 PM Nov 12th, 2:30 PM

False estimates of predicted low acuity complaints in the prehospital and Emergency environments

Watkins 2141

Objectives:This study compares the determination of appropriateness for Urgent Care (UCC) as assessed by retrospective chart evaluation to that of actual disposition recommendations made by practicing Alternate Destination Paramedics (ADPs).

Methods: In September 2015, as part of the State of California EMS Authority (EMSA) Community Paramedicine pilot project, the Orange County Fire Chiefs Association (OCFCA) initiated an Alternate Destination project. The project provided paramedics from participating departments additional training, and then permitted them to offer adult patients with specific low-acuity complaints transport to UCC instead of ED. Investigators collected baseline data to estimate potentially eligible pilot patients, using an evaluation protocol retrospectively applied to patient care records by research physicians. Instructors taught paramedic trainees to consider patients appropriate for UCC based on the protocol, with the added instruction to evaluate whether the patient would be able to return to the home environment after 3-4 hours of care at an UCC, based on chief complaint and functional status with their current injury/illness. The research team obtained preliminary aggregate data on eligible patients for comparison to the baseline period.

Results: In the seven-months baseline period, participating fire departments completed 11,814 patient transports; 737 patients (6.4%) presented with the included chief complaints and were deemed potentially appropriate for UCC evaluation by application of the study protocol. During the first 6 months of the program, 13,622 patients were transported. Using clinical judgment guided by protocol, trained ADPs designated only 84 patients appropriate for UCC (0.6%).

Conclusion: Trained paramedics using clinical judgment deemed few patients appropriate for UCC. In addition, more than 25% of patients deemed appropriate by paramedic judgment were contacted during time periods when alternatives to ED care were unavailable. It is likely that many previous studies estimating unnecessary EMS transports and ED visits significantly over-estimate frequency of inappropriate ED presentations.