Innovative Use of Emergency Medicine Providers in an Urban Setting to Reduce Overutilization of 9-1-1.

Abstract

Emergency Departments (ED) and Emergency Medical Services (EMS) are relied on to address nonemergent needs causing long ED wait times. Baltimore City EMS provided over 100,000 transports, many for low-acuity medical needs. Minor Definitive Care Now (MDCN) is designed to address low-acuity complaints and decrease ED visits. MDCN provides low-acuity 9-1-1 callers the option of on-scene evaluation and treatment. For patients requiring additional resources, but not needing an ED, an alternate destination is considered. Patients were screened low acuity by EMS personnel and voluntarily enrolled in MDCN. A questionnaire was given to patients after their visit to assess satisfaction. CRISP, a database for hospital visits in Maryland, was reviewed to assess if patients went to the ED after an MDCN visit. In 1year of service, 168 calls were screened, with 144 patients consenting to treatment by the MDCN team. Of enrolled patients: 94 (65%) were treated on the scene, 37 (26%) were transported to an urgent care facility, 1 (0.6%) was transported to their primary care provider for a same-day appointment, and 12 (8.4%) were transported to the ED after further evaluation. Of the 94 patients treated on scene, 3 (3.2%) presented to a local ED in the surrounding area within 72h. On review, there were no safety issues identified or deficits in the clinical care provided on scene. This innovative model of on-scene evaluation and treatment can potentially reduce transports, decrease ED wait times, and reduce costs, in an effective and efficient way.