An emergency medical services program of alternate destination of patient care.
OBJECTIVE
The emergency department (ED) is ideally reserved for urgent health needs. The ED, however, is often the site of care for nonurgent conditions. The authors investigated whether emergency medical technicians could decrease ED use by patients with nonurgent concerns who use 911 by appropriately identifying and triaging them to alternate care destinations.


METHODS
From August 2000 through January 2001, two King County fire-based emergency medical services (EMS) agencies participated in an alternate care destination program for patients with specific low-acuity diagnosis codes (intervention group). Eligible patients were offered care at a clinic-based destination as an alternate to the ED (n = 1,016). The frequency of the destination of care (ED, clinic, or home) for the intervention group was compared with a matched control group that was comprised of a preintervention historical cohort of EMS encounters from the same two fire-based agencies and with the same acuity and diagnosis criteria and seasonal interval (n = 2,617).


RESULTS
Compared with the preintervention group, a smaller proportion of patients in the intervention group received care in the ED (44.6% vs. 51.8%, p = 0.001), while a greater proportion of patients in the intervention group received clinic care (8.0% vs. 4.5%, p = 0.001) or home care (no transport) (47.4 vs. 43.7%, p = 0.043). Results were comparable when adjusted for other patient characteristics. Similar relationships were not evident among nonparticipating King County EMS agencies. Based on physician review and patient interview, the alternate care intervention appeared to be safe and satisfactory.


CONCLUSIONS
An EMS-based program may represent one approach to limiting nonurgent ED use.
University of Washington School of Medicine, Seattle, USA.
Rebecca A
RA
Schaefer
Thomas D
TD
Rea
Michele
M
Plorde
Kraig
K
Peiguss
Paul
P
Goldberg
John A
JA
Murray
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000458:organization & administration*; D004634:Emergency Medical Technicians / Q000193:education* / Q000592:standards; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D011361:Professional Competence; D016730:Program Development; D015397:Program Evaluation; D016019:Survival Analysis; D014218:Triage / Q000379:methods*; D014861:Washington; D014947:Wounds and Injuries / Q000145:classification / Q000175:diagnosis / Q000628:therapy*