The following article is a part of conference coverage from the 2021 American Association of Nurse Practitioners National Conference (AANP 2021), held virtually from June 15 to June 20, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading NPs. Check back for more from AANP 2021.
A multidisciplinary model that provides on-site care to patients with low-acuity medical complaints can potentially reduce the burdens on both emergency department teams and emergency medical systems (EMS) services, according to research findings presented at the 2021 American Association of Nurse Practitioners National Conference (AANP 2021).
“This innovative model of on-scene evaluation and treatment can potentially reduce unnecessary ambulance transports, increase operational efficiency of an EMS system, decrease [emergency department] wait times, and reduce health care costs,” according to Suzanna Fitzpatrick, DNP, CRNP, and colleagues from the University of Maryland Medical Center. “This was all done while maintaining patient safety and optimizing health and clinical outcomes.”
Per capita, Baltimore City is the second busiest EMS department in the US. In 2017, EMS responded to 150,000 EMS calls, many of which are for “low acuity needs.” Currently, both emergency departments and EMS are being used as a way for individuals to address routine medical needs, leading to long wait times and overcrowding in emergency department settings. In Maryland, 9-1-1 call volume increased by 8.6% between 2015 and 2017. Of these 9-1-1 calls, 60% of all EMS transports were for potentially nonemergent services.
To decrease emergency department visits and reduce the burden on both emergency rooms and EMS services, the University of Maryland Medical Center and the Baltimore City Fire Department developed Mobile Definitive Care Now (MDCN), a multidisciplinary model that provides care for low-acuity needs outside of the hospital setting.
MDCN is HIPAA compliant and relies on hospital-based electronic medical records (EMRs) for review and documentation. The platform allows team members to securely send text messages, send electronic prescriptions to community pharmacies, and consult a medical provider, social worker, pharmacist, or community health worker via telemedicine.
The MDCN system activates when a patient calls 9-1-1. The call center remains responsible for assigning call priority. For “standard” emergency calls, callers are provided a 9-1-1 emergency vehicle dispatch, evaluated on-scene by EMS, transported, and handed off to hospital care. For patients who consented to MDCN treatment, an MDCN team is attached to the dispatch. Medical evaluation is conducted on-scene; if the complaint is low acuity, the patient receives MDCN team treatment and is provided discharge papers or transported to urgent care. For calls that are not low acuity, the patient is transported by 9-1-1 per current policy. Importantly, if the patient participates in the MDCN evaluation, the 9-1-1 emergency vehicle sent to the scene is released back into service.
Within 1 year of implementation, 168 9-1-1 calls were screened. Of the 144 patients who consented to receive MDCN treatment, 94 were treated on the scene and discharged, 37 were transferred to urgent care, 12 were transferred to the emergency department via EMS, and 1 was sent to primary care for a same-day appointment. Importantly, only 3.2% of patients treated on-scene later presented to a local emergency department within 72 hours.
The most common complaints among patients who received MDCN treatment were extremity injuries (26.2%) followed by abdominal pain, nausea, and vomiting (11.9%), acute wounds (11.1%), and motor vehicle accidents (11.1%).
Results of a patient satisfaction questionnaire were highly positive, with 99% of patients reporting that they felt respected and 97% reporting that all of their questions were answered clearly. In total, 99% of patients stated that they were satisfied with the care and 93% preferred the MDCN program to going to the hospital.
Limitations of the current program are its lack of generalizability to areas outside of West Baltimore, its reliance on caller information to determine MDCN dispatch, and its grant funding.
The next steps for the MDCN project include expanded hours and catchment area, a mobile laboratory for diagnostics, and locating a sustainable source of funding, according to the study investigators.
Visit Clinical Advisor’s meetings section for complete coverage of AANP 2021. All conference sessions are available to registered attendees through August 31, 2021.
Fitzpatrick S, Somers S, Brown J, Landi C, Gingold D, Marcozzi D. Innovative use of emergency medicine providers to reduce overutilization of 9-1-1. Poster presented at: 2021 American Association of Nurse Practitioners National Conference; June 15-June 20, 2021. Poster 18.