Emergency Care Providers Research Articles

Training of interns in the system of medical triage of patients on the basis of the Simulation Center of the Kazakh National Medical University

Providing emergency care to patients is a basic skill for doctors of any specialty. Emergency department overcrowding is a pressing public health problem that affects countries around the world. Medical Triage or triage is the process of prioritizing medical care for patients based on the severity of their condition.

THE START SORTING SYSTEM AND THE NURSE’S PARTICIPATION IN ITS IMPLEMENTATION

Introduction. This article highlights the problem of organizing the sorting of patients during mass admission to medical institutions and providing emergency medical care. The role of the nurse in conducting triage and providing emergency care at the early hospital stage is within the framework of limited resources. The urgency of working out the response protocol in the event of an emergency. The aim of the study – to determine the role of the nurse in the triage and provision of emergency care at the early hospital stage within the framework of a limited resource. To establish the relevance of the use of the START medical triage system in the practical activities of a nurse. The relevance of working out the response protocol in the event of an emergency among nurses. The main part. The medical triage system START (Simple Triage and Rapid Treatment) is an effective tool for organizing and accelerating the process of correct routing of patients in mass cases and crises when resources are limited and medical needs are high. Medical triage criteria also include signs of primary medical examination. As their professional responsibilities expand, nurses can use the ABCD algorithm to assess the patient’s condition. Knowledge of the principles of this medical triage system, the ability to provide emergency medical care, evenly and effectively distribute resources, follow the instructions of the coordinating physician, describe medical documentation, and label the patient’s category have become the duties of nurses due to the increasing frequency of emergencies. Conclusions. The START (Simple Triage and Rapid Treatment) triage system is used for prompt and efficient selection of victims during emergencies. The role of the nurse in this process is extremely important. First of all, the nurse must have skills in the application of the START triage technique and an understanding of its basics. During triage, the nurse can quickly assess the condition of each victim, determine the category, and assign the appropriate color tag. Provision of emergency medical care in conditions of limited resources, coordination, and reporting for further organization of medical care are key elements in the formation of nursing competence during triage. Using the principles of medical triage can help optimize treatment and save more lives in emergencies.

Quality improvement initiative: improving obstetric triaging practices in a rural maternal hospital in central India

Triaging of obstetric patients by emergency care providers is paramount. It helps provide appropriate and timely management to prevent further injury and complications. Standardised trauma acuity scales have limited applicability...

Standards for providing emergency care at the prehospital and early hospital stages for patients with mechanical jaundice

Mechanical jaundice is a condition characterized by obstructive disorders in the biliary system, posing a diagnostic challenge that requires advanced visualization techniques and laboratory tests for accurate diagnosis. This article explores the role of biochemical markers, presents an analysis of the algorithm for laboratory diagnosis and visualization techniques in order to stratify patients with jaundice syndrome, and conduct timely and effective conservative treatment with further surgical interventions. A comprehensive diagnostic and therapeutic algorithm has been developed whose use by emergency physicians at the prehospital and early hospital stages will lead to a rapid and qualitative elimination of biliary obstruction, a reduction in the level of complications, and the achievement of optimal treatment outcomes for patients.

Improving care pathways for children with severe illness through implementation of the ASPIRE mHealth primary ETAT package in Malawi.

Providing emergency care in low resource settings relies on delivery by lower cadres of health workers (LCHW). We describe the development, implementation and mixed methods evaluation of a mobile health (mHealth) triage algorithm based on the WHO Emergency, Triage, Assessment, and Treatment (ETAT) for primary-level care. We conducted an observational study design of implementation research. Key stakeholders were engaged throughout implementation. Clinicians and LCHW at eight primary health centres in Blantyre district were trained to use an mHealth algorithm for triage. An mHealth patient surveillance system monitored patients from presentation through referral to tertiary and final outcome. A total of 209,174 children were recorded by ETAT between April 2017 and September 2018, and 155,931 had both recorded mHealth and clinician triage outcome data. Concordance between mHealth triage by lower cadres of HCW and clinician assessment was 81·6% (95% CI [81·4, 81·8]) over all outcomes (kappa: 0·535 (95% CI [0·530, 0·539]). Concordance for mHealth emergency triage was 0.31 with kappa 0.42. The most common mHealth recorded emergency sign was breathing difficulty (74·1% 95% CI [70·1, 77·9]) and priority sign was raised temperature (76·2% (95% CI [75·9, 76·6]). A total of 1,644 referrals out of 3,004 (54·7%) successfully reached the tertiary site. Both providers and carers expressed high levels of satisfaction with the mHealth ETAT pathway. An mHealth triage algorithm can be used by LCHWs with moderate concordance with clinician triage. Implementation of ETAT through an mHealth algorithm documented successful referrals from primary to tertiary, but half of referred patients did not reach the tertiary site. Potential harms of such systems, such as cases requiring referral being missed during triage, require further evaluation. The ASPIRE mHealth primary ETAT approach can be used to prioritise acute illness and support future resource planning within both district and national health system.

Leaving emergency departments without completing treatment among First Nations and non-First Nations patients in Alberta: a mixed-methods study.

Our previous research showed that, in Alberta, Canada, a higher proportion of visits to emergency departments and urgent care centres by First Nations patients ended in the patient leaving without being seen or against medical advice, compared with visits by non-First Nations patients. We sought to analyze whether these differences persisted after controlling for patient demographic and visit characteristics, and to explore reasons for leaving care. We conducted a mixed-methods study, including a population-based retrospective cohort study for the period of April 2012 to March 2017 using provincial administrative data. We used multivariable logistic regression models to control for demographics, visit characteristics, and facility types. We evaluated models for subgroups of visits with pre-selected illnesses. We also conducted qualitative, in-person sharing circles, a focus group, and 1-on-1 telephone interviews with health directors, emergency care providers, and First Nations patients from 2019 to 2022, during which we reviewed the quantitative results of the cohort study and asked participants to comment on them. We descriptively categorized qualitative data related to reasons that First Nations patients leave care. Our quantitative analysis included 11 686 287 emergency department visits, of which 1 099 424 (9.4%) were by First Nations patients. Visits by First Nations patients were more likely to end with them leaving without being seen or against medical advice than those by non-First Nations patients (odds ratio 1.96, 95% confidence interval 1.94-1.98). Factors such as diagnosis, visit acuity, geography, or patient demographics other than First Nations status did not explain this finding. First Nations status was associated with greater odds of leaving without being seen or against medical advice in 9 of 10 disease categories or specific diagnoses. In our qualitative analysis, 64 participants discussed First Nations patients' experiences of racism, stereotyping, communication issues, transportation barriers, long waits, and being made to wait longer than others as reasons for leaving. Emergency department visits by First Nations patients were more likely to end with them leaving without being seen or against medical advice than those by non-First Nations patients. As leaving early may delay needed care or interfere with continuity of care, providers and departments should work with local First Nations to develop and adopt strategies to retain First Nations patients in care.

Remote Ischemic Postconditioning in Case of Traumatic Brain Injury: a Review of Experimental and Clinical Studies

Relevance Traumatic brain injury (TBI) remains one of the leading causes of morbidity and mortality worldwide. Despite advances in treatment based on understanding of the mechanisms of brain injury after TBI, there is a clear need for new therapeutic strategies. Remote ischemic postconditioning (RIPostC) can be considered as a non-pharmacological technique to reduce secondary brain damage and improve clinical outcomes in patients with TBI.Aim of study Raising awareness of emergency physicians, neurosurgeons, neurologists, neurophysiologists about the possible use of the concept of RIPostC in patients with TBI.Material and methods To achieve this goal, the Results of clinical and experimental studies of the use of RIPostC after TBI were analyzed. Literature search was carried out in electronic search systems PubMed (https://pubmed.ncbi.nlm.nih.gov), eLibrary (https://elibrary.ru) using the keywords: “traumatic brain injury”, “remote ischemic conditioning”. A systematic search and selection of publications was performed in January–February 2023. The results of the review included patients with an established diagnosis of traumatic brain injury, followed by the use of RIPostC and animals with experimental modeling of TBI in various ways, followed by RIPostC.Conclusion The totality of data suggests that the use of the concept of RIPostC as a non-invasive protective technique in the provision of emergency care for patients with TBI may contribute to limiting secondary brain damage. However, the underlying neuroprotective processes are quite complex and need further study. Establishing the relationship of humoral, neurogenic and inflammatory reactions in response to the use of RIPostC in TBI will contribute to understanding the mechanisms of emerging neuroprotection, help ease the course of the disease and improve the clinical outcome.

Computer Model for Detecting Cervical Spine Fractures based on Computed Tomography Images

The paper discusses methods of detecting cervical spine fractures based on computed tomography images using machine learning algorithms. Solving such a problem is important in the context of providing emergency care to patients with suspected spinal fractures, when accurate decision-making based on radiological data can be critical. In this case, such a machine learning model can speed up the work of a radiologist and reduce the importance of the human factor in making important decisions. After a review of analogs from the literature, it has been found that convolutional neural networks appear to be the most promising method. Using a publicly available dataset, a model "Fracture detection 3" based on a convolutional neural network is developed to solve the problem. The model demonstrates a classification accuracy of 98.25%, sensitivity of 99%, and specificity of 97.5%, which is ahead of the literature. For comparison with traditional methods, models based on the support vector method, decision tree, and k-nearest method are developed using a similar dataset. "Fracture detection 3" outperforms all developed models based on traditional methods in terms of classification accuracy.

Emergency care provision for exotic pets.

Emergency care provision for exotic pets.

Assertive community treatment for high-utilizing alcohol misuse patients: a before-and-after cohort study protocol

BackgroundThe challenge posed by Alcohol-Related Frequent Attenders (ARFAs) in Emergency Departments (EDs) is growing in Singapore, marked by limited engagement with conventional addiction treatment pathways. Recognizing this gap, this study aims to explore the potential benefits of Assertive Community Treatment (ACT) - an innovative, community-centered, harm-reduction strategy—in mitigating the frequency of ED visits, curbing Emergency Medical Services (EMS) calls, and uplifting health outcomes across a quartet of Singaporean healthcare institutions.MethodsEmploying a prospective before-and-after cohort design, this investigation targeted ARFAs aged 21 years and above, fluent in English or Mandarin. Eligibility was determined by a history of at least five ED visits in the preceding year, with no fewer than two due to alcohol-related issues. The study contrasted health outcomes of patients integrated into the ACT care model versus their experiences under the exclusive provision of standard emergency care across Hospitals A, B, C and D. Following participants for half a year post-initial assessment, the evaluation metrics encompassed socio-demographic factors, ED, and EMS engagement frequencies, along with validated health assessment tools, namely Christo Inventory for Substance-misuse Services (CISS) scores, University of California, Los Angeles (UCLA) Loneliness scores, and Centre for Epidemiologic Studies Depression Scale Revised (CESD-R-10) scores.DiscussionConfronted with intricate socio-economic and medical challenges, the ARFA cohort often grapples with heightened vulnerabilities in relation to alcohol misuse. Pioneering the exploration of ACT’s efficacy with ARFAs in a Singaporean context, our research is anchored in a patient-centered approach, designed to comprehensively address these multifaceted clinical profiles. While challenges, like potential high attrition rates and sporadic data collection, are anticipated, the model’s prospective contribution towards enhancing patient well-being and driving healthcare efficiencies in Singapore is substantial. Our findings have the potential to reshape healthcare strategies and policy recommendations.Trial RegistrationClinicalTrials.gov, NCT 04447079. Initiated on 25 June 2020.

The lived experiences of healthcare professionals working in pre-hospital emergency services in Jordan: A qualitative exploratory study

IntroductionGlobally, injuries account for 9% of all deaths, with road accidents contributing to approximately a quarter of these fatalities. A major concern is the inadequacy of pre-hospital care (emergency medical services provided before arrival at a hospital) and delays in transportation to medical facilities, identified as leading causes of preventable injury-related deaths. This study explores the experiences of emergency health professionals (EHPs) in peri-hospital services (emergency medical services provided immediately upon arrival and within the hospital setting). MethodsA qualitative exploratory design, underpinned by Van Manen’s (1990) descriptive phenomenological principles, was used. Thirty EHPs from five central and southern Jordanian emergency departments were purposefully sampled, including physicians, nurses, and paramedics from both emergency departments and pre-hospital services. ResultsTwo primary themes emerged: (1) In Search of Clarity: The Unsettled Journey of Pre-hospital Emergency Care Providers; (2) Frustrations on the Frontline: Role Ambiguity and Emotional Exhaustion in Trauma Care, with EHPs reporting fluid and unclear roles, physical and verbal abuse, and limited authority in critical interventions. ConclusionThe study highlights several service lapses in peri-hospital care that negatively impact healthcare professionals, posing risks to patient safety. These findings urge decision-makers to devise actionable strategies to rectify these deficiencies, enhancing care quality and thereby decreasing injury-induced mortality and morbidity.

The influence of supportive work environment on work-related stress and conflict management style among emergency care nurses: A descriptive correlational study.

Stress and conflict in emergency departments are inevitable but can be managed. A supportive work environment is key to helping emergency care providers, especially nurses, constructively manage work-related stress and conflict. The aim of this study was to assess the influence of supportive work environments on work-related stress and conflict management style among emergency care nurses. A descriptive correlational research design was utilized. Data were collected from 221 staff nurses recruited from two university hospital emergency departments in Alexandria, Egypt. Three instruments were used: (1) perceived organizational support scale, (2) nurses' occupational stressors scale, and (3) conflict management style inventory. There was a highly significant correlation between supportive work environments and work-related stress (p = .000) and a significant correlation between supportive work environments and conflict management style (p = .026). Supportive work environments had a significant inverse negative relationship with work-related stress experienced by nurses (p = .001) and accounted for 51% of variance in work-related stress. Meanwhile, supportive work environments had a significant positive relationship with conflict management styles of nurses (p = .026). Work-related stress had a significant relationship with nurses' conflict management style (p = .000) and accounted for 45% of the variance in conflict management style. The style of conflict management modeled by staff within emergency departments can positively or negatively influence the work environment and level of work-related stress. There is a necessity to cultivate a supportive culture for nurses in emergency departments to develop skills for constructive conflict management styles to reduce work-related stress.

Understanding patient, caregiver, and healthcare provider perspectives of the management of long-chain fatty acid oxidation disorders.

Long-chain fatty acid oxidation disorders (LC-FAODs) are a group of rare, inherited, metabolic disorders that can lead to a wide range of symptoms that predominantly affect organ systems with high energy needs, such as the heart, liver, skeletal muscle, and nervous system. Clinical management primarily consists of close attention to and monitoring of diet and activity and avoidance of prolonged fasting. In addition, patients and caregivers must be alert for signs of life-threatening metabolic decompensation. As a result, LC-FAODs can have significant and wide-ranging impacts on the lives of patients and their caregivers. This article describes the effects of LC-FAODs at different life stages and in the context of the North American healthcare system from the perspective of a group of patients, caregivers, and healthcare providers (n = 6). We explain how challenges and needs change throughout life. Following an early diagnosis, an adjustment phase occurs during which caregivers may feel overwhelmed by their new roles and deeply concerned for their children's futures. As children grow, they become more aware of the differences between themselves and their peers, and with increasing independence comes more responsibility for managing their own condition. Major life events, such as new employment and moving house, pose challenges for people of all ages. In addition, it may be difficult to find and connect with qualified and experienced healthcare providers; navigate the health insurance system; and educate and align primary, specialist, and emergency care providers. We propose several strategies to improve the care of patients with LC-FAODs, such as educating local healthcare teams, improving trust between patients/caregivers and healthcare providers, and raising awareness of the challenges faced by patients and caregivers across the different life stages.

From Fragmentation to Integration in Emergency Medicine: Providing Care Our Patients Deserve

The emergency care systems of most communities around the world have multiple components through which patients move and which are, at best, disjointed and not well coordinated. Illnesses and injuries which begin in the community and frequently preventable often do not have the benefit of bystander assistance or dedicated immediate emergency ambulance care and arrive at Emergency Departments that are crowded. Patients often spend long hours in these Emergency Departments and, if requiring inpatient care, have to wait many hours before an inpatient bed becomes available. Those requiring further convalescent care may often find inadequate arrangements available for them to recover smoothly. The end result is delays and adverse clinical outcomes that are often not measured or even appreciated. This report discusses each of ten components of the emergency care system as in exists in most communities, including injury and illness prevention, the community burden of emergencies, bystander first responder care, ambulance-based second responder care, emergency department crowding and its contributory factors, transitions of care to the inpatient departments and community convalescent care units, coordination of emergency departments in the community, the patient’s family and, of course, the emergency patient. The effects of fragmentation in each of these components are described and strategies to address each mentioned. There is a need for a patient-centric, integrated approach to the provision of emergency care in any community which can break down the barriers created by fragmented care and provide the seamless, high-quality care that all our patients deserve.

Evaluating the Effectiveness of a First Aid Training Programme for Individuals Without a Background in Medical Education.

People without a medical education background who have the skills and knowledge to provide emergency care can be useful in emergencies, disasters, earthquakes, and pandemics to save or support the life of an injured person until hospitalization or the arrival of an emergency medical team. The purpose of the study is to assess the knowledge and skills of first aid in individuals without a medical education background within a year after training. The study sample included 643 people without a medical education background. The study participants attended basic first aid training, the sessions that lasted for 18 hours. Participants answered a 10-question skills test before and after completing the course, as well as 6 months and 1 year after training. SPSS version 20.0 (IBM Ireland Product Distribution Limited, Ireland) was used for the statistical assessment of data, employing Cochran's Q test. Pairwise comparisons were made between different periods using the Wilcoxon test with Bonferroni correction. The mean age of the participants was 36 for males, and 42 for females. In the sample, males accounted for 70% (n = 441) and females for 30% (n = 202). The first aid training provided to persons without a medical education background significantly increased their level of knowledge. After 6 and 12 months, their knowledge and abilities remained significantly higher than before the training. However, these results were lower than they had been immediately after training. The study demonstrated that first aid training significantly increased the knowledge level of non-medical individuals immediately after training and remained elevated after 6 and 12 months. However, there was a decline in the level of knowledge and skills over time, indicating the need for refresher training.

Addressing the social determinants of health: social workers as key players in integrated care

Organizing health care requires addressing the social determinants of health, broadly defined as the social, economic, and environmental factors that influence health outcomes. However, this is often beyond the scope, expertise, and time of medical professionals. As a result, there is an increasing tendency towards interprofessional collaboration in general, with the involvement of social workers in specific. Given the profession’s expertise in ameliorating social problems with respect to different areas of life, social workers are well-equipped to address social determinants in health care settings. In practice, however, the position, roles, and added value of social work are still rather ambiguous and unclear. It is therefore necessary to generate theoretical grounding and empirical evidence on the role of social work in diverse health care settings. The aim of this workshop is twofold. First, we will present the current state-of-the-art in the literature. Second, we will initiate a dialogue to reflect on the meaning and potential of social work in diverse health care systems. In this way, we want to establish an international dialogue aimed at the exchange of differences and similarities. We would like to engage with both healthcare providers (general practitioners, paramedics, …) as well as policy makers and researchers.
 The workshop consists of three parts. First, the researchers will introduce the topic. Second, participants will be divided into groups and provided with questions related to a case study. The researchers will join these groups to facilitate and summarize the discussion. Third, the researchers will briefly present their own research findings on the following subthemes:
 1) The perception of social work and search for collaboration according to general practitioners in Flanders (Nele Feryn)
 Through semi-structured interviews, general practitioners were asked about the impact of social problems in their practice, their views on social work, collaboration and perceived barriers to shape this cooperation.
 2) The transformative potential of social workers in Doctors of the World (Didier Boost)
 Based on a critical realist evaluation, the role of social workers in Doctors of the World is explored in Antwerp, Belgium. Doctors of the World, an international humanitarian NGO, aims to realize the right to health(care) for vulnerable communities without access to regular care. In addition to the direct provision of emergency and long-term medical care, the organization strives for structural change and advocates for social justice. This practice can potentially provide an ‘enabling niche’ that aligns with the rights-based focus of the social work profession.
 3) The involvement of social workers in Flemish palliative care settings (Brent Taels)
 Through survey questionnaires and focus groups, social workers in Flemish primary and secondary care settings were asked about their involvement in palliative care and the level of appreciation they receive from other care professionals. These findings form the basis for the future development of an intervention to extend the role of social workers in this field.
 Time schedule: 10 min. introduction + 15 min. of groupwork + 10 min. plenary discussions + 20 min. presentations of the subthemes + 5 min. closing discussion
 

Early Triage and Emergency Obstetric Care in High-Risk Pregnancies and Impact on Their Outcome; A Cross-Sectional Study

Objective: To assess the role of early triage and emergency obstetric care for high-risk pregnancies and their outcome. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Bahawalpur Pakistan, from Jan 2021 to Jun 2022. Methodology: Women with high-risk pregnancies, aged 18-40 years, gestational age >28 weeks, were included. Emergency obstetric care was provided to participants of the study. Maternal outcome was assessed regarding their hospital stay duration, morbidity, mortality and mode of delivery. The fetal outcome was in terms of intra-uterine death (IUD), Early neonatal death (ENND), and live births. Results: The mean age of patients was 28.1±3.49 years. Most of the patients belonged to high-order cesarean section and hypertensive disorders of pregnancy. 94.3% were delivered by cesarean section due to obstetric reasons, and hospital stay was an average of> 72 hours in 57.7 %. Maternal mortality and morbidity were not observed. 99.9% of babies were live births, 0.7% ended into ENND, and one received an IUD. Conclusion: Early triage followed by the provision of emergency obstetric emergency care is recommended in high-risk pregnancies for optimum feto-maternal outcome.

Improving the Maternity Care Safety Net: Establishing Maternal Mortality Surveillance for Non-Obstetric Providers and Institutions.

The siloed nature of maternity care has been noted as a system-level factor negatively impacting maternal outcomes. Veterans Health Administration (VA) provides multi-specialty healthcare before, during, and after pregnancy but purchases obstetric care from community providers. VA providers may be unaware of perinatal complications, while community-based maternity care providers may be unaware of upstream factors affecting the pregnancy. To optimize maternal outcomes, the VA has initiated a system-level surveillance and review process designed to improve non-obstetric care for veterans experiencing a pregnancy. This quality improvement project aimed to describe the VA-based maternal mortality review process and to report maternal mortality (pregnancy-related death up to 42 days postpartum) and pregnancy-associated mortality (death from any cause up to 1 year postpartum) among veterans who use VA maternity care benefits. Pregnancies and pregnancy-associated deaths between fiscal year (FY) 2011-2020 were identified from national VA databases. All deaths underwent individual chart review and abstraction that focused on multi-specialty care received at the VA in the year prior to pregnancy until the time of death. Thirty-two pregnancy-associated deaths were confirmed among 39,720 pregnancies (PAMR = 80.6 per 100,000 live births). Fifty percent of deaths occurred among individuals who had experienced adverse social determinants of health. Mental health conditions affected 81%. Half (n = 16, 50%) of all deaths occurred in the late postpartum period (43-365 days postpartum) after maternity care had ended. More than half of these late postpartum deaths (n = 9, 56.2%) were related to suicide, homicide, or overdose. Integration of care delivered during the perinatal period (pregnancy through postpartum) from primary, mental health, emergency, and specialty care providers may be enhanced through a system-based approach to pregnancy-associated death surveillance and review. This quality improvement project has implications for all healthcare settings where coordination between obstetric and non-obstetric providers is needed.

EMS Interventions during Planned Out-of-Hospital Births with a Midwife: A Retrospective Analysis over Four Years in the Polish Population.

Planned out-of-hospital births, facilitated by highly skilled and experienced midwives, offer expectant parents a distinct opportunity to partake in a personalized, intimate, and empowering birth experience. Many parents opt for the care provided by midwives who specialize in supporting home births. This retrospective study is based on 41,335 EMS emergency calls to women in advanced pregnancy, of which 209 concerned home birth situations documenting obstetrical emergencies over four years (January 2018 to December 2022), of which 60 involved the assistance of a midwife. Data were obtained from the Polish Central System for Emergency Medical Services Missions Monitoring, encompassing all EMS interventions in pregnant women. The most frequent reason for emergency calls for obstetrical emergencies with the assistance of a midwife was a failure to separate the placenta or incomplete afterbirth (18 cases; 30%), followed by perinatal haemorrhage (12 cases; 20%) and deterioration of the newborn's condition (8 cases; 13%). Paramedic-staffed EMS teams conducted most interventions (43 cases; 72%), with only 17 (28%) involving the presence of a physician. Paramedics with extensive medical training and the ability to provide emergency care are in a unique position that allows them to play a pivotal role in supporting planned out-of-hospital births. The analysed data from 2018-2022 show that EMS deliveries in Poland are infrequent and typically uncomplicated. Continuing education, training, and adequate funding are required to ensure the EMS is ready to provide the best care. EMS medical records forms should be adapted to the specific aspects of care for pregnant patients and newborns.

Medical advice lines offering on-demand access to providers reduced emergency department visits.

Instant access to clinicians through virtual care is designed to allow patients to receive care they need while avoiding high-cost visits in acute-care settings. This study investigates the effect of offering patients the option to instantly connect with emergency care providers instead of being referred to the emergency department (ED) following calls to a medical advice line. We used a staggered rollout design to assess the effects of implementing this program on key outcomes among Veterans Affairs enrollees. Analyzing over 1 million calls from 2019 to 2022, we found that access to a provider reduced the proportion of patients who subsequently visited the ED compared with those with access to the standard medical advice line (38% vs 36%). There was no significant difference observed in subsequent inpatient admissions or 30-day mortality. We found that a majority of callers (65%) achieved issue resolution or were directed to lower acuity settings for further evaluation. Although substantial direct cost savings were not evident, our findings demonstrate that on-demand access to a virtual provider can effectively decrease ED visits.