Identifying Need for Advanced Practitioners in the Prehospital Setting with Evidence-Based Recommendations

Abstract

Purpose: The purpose of this quality improvement (QI) project was to review and analyze de-identified data from non-emergent EMS calls to provide quality improvement recommendations for the Avondale Fire and Medical (AFM) department, specifically focusing on when to recommend an advanced practitioner, to reduce non-essential hospital transports, lower healthcare costs, and enhance patient outcomes in the City of Avondale.Background: Over the past decade, the United States (US) healthcare system has seen excessive costs, largely due to unnecessary hospital services and readmission penalties for hospitals. To address these issues, advanced practitioner-led community paramedicine programs have gained large amounts of recognition with promising results in reducing non-emergent hospital transports, cutting costs, and improving patient outcomes. Methodology: The method of this project included analyzing de-identified EMS call data from AFM’s Low Acuity (LA) Unit from January to June 2023, focusing on patient acuity, primary impression, level of care provided, and transport dispositions to provide evidence-based recommendations for incorporating advanced practitioners in the prehospital setting and reducing non-emergent hospital transports. Results: Out of 767 de-identified incidents, 74.7% of AFM’s LA Unit calls resulted in hospital transport. However, 89.7% of those transports received a BLS level of care and 90.2% were identified as non-emergent. “Ill/Ill Person,” “Injured Person,” and “No Apparent Illness” made up the majority, 22.6%, 18.4%, and 16.6% respectively, of the transported primary impressions. Conclusion: Data analysis revealed a significant proportion of non-emergent hospital transports, prompting recommendations to integrate advanced practitioners in responding to non-emergent calls and non-specific primary impressions with the goal of reducing hospital transports.