EMS directing low-acuity patients to destinations besides hospitals holds great promise for reducing healthcare costs and improving patients' experiences. But for such projects to succeed, medics have to be accurate in determining which patients to redirect. They have to correctly identify who can be safely diverted to non-ED care locations.
Data from the Orange County Fire Chiefs Association's alternative-destinations pilot suggests that, at least in the case of this California program, they are doing that successfully.
The project was launched in 2015 as part of the state's group of CP pilot projects. It was intended to let paramedics take low-acuity patients to urgent care centers rather than hospital emergency departments. Outside groups, authors from the University of California at Irvine noted, "expressed concern that paramedics would be unable to differentiate low-acuity patients from those with significant illness."
Those medics received four hours of extra education toward identifying low-acuity candidates, who included patients with extremity injuries, soft tissue infection or injury, lacerations with controlled bleeding, cough and/or fever. Qualified and agreeable patients then went to urgent care, and transporting FD personnel collected outcomes data, which they provided to investigators at UCI's Center for Disaster Medical Sciences. Paramedics' dispatch recommendations were judged appropriate if patients were transported to and then discharged from urgent care, or if they were transported to an ED and discharged within six hours.
Preliminary results were published in the Annals of Emergency Medicine in October. Based on that data, the authors concluded, "We anticipate that overall data will demonstrate...trained paramedics make safe and appropriate disposition recommendations for patients with selected low-acuity complaints." Such a finding, they note, "would directly contradict previous studies that demonstrated significant paramedic undertriage of prehospital patients."