Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments.
BACKGROUND
Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program.


METHODS
The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group.


RESULTS
During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%,P<.001). EMS productivity (median time from EMS notification to unit back in service) was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median). There were no statistically significant differences in mortality or patient satisfaction.


CONCLUSIONS
We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.
The University of Texas Health Science Center, Departments of Emergency Medicine and Biomedical Informatics, Houston, Texas.
James R
JR
Langabeer
Baylor College of Medicine, Department of Emergency Medicine, Houston, Texas; Houston Fire Department, Emergency Medical Services, Houston, Texas.
Michael
M
Gonzalez
Houston Fire Department, Emergency Medical Services, Houston, Texas.
Diaa
D
Alqusairi
The University of Texas Health Science Center, School of Biomedical Informatics, Houston, Texas.
Tiffany
T
Champagne-Langabeer
City of Houston Health and Human Services, Division Manager, Houston, Texas.
Adria
A
Jackson
The University of Texas Health Science Center, Research Manager, Houston, Texas.
Jennifer
J
Mikhail
Houston Fire Department, Emergency Medical Services, Houston, Texas.
David
D
Persse
D000328:Adult; D000552:Ambulances; D016022:Case-Control Studies; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000193:education / Q000592:standards; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000592:standards; D012189:Retrospective Studies; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods*; D014218:Triage / Q000379:methods / Q000592:standards