Innovative Use of Emergency Medicine Providers in an Urban Setting to Reduce Overutilization of 9-1-1

Background: Emergency Departments (ED) and Emergency Medical Services (EMS) are relied on to address nonemergent needs causing long ED wait times. Baltimore City EMS provided over 100,000 transports, many for low-acuity medical needs.

Objective: Minor Definitive Care Now (MDCN) is designed to address low-acuity complaints and decrease ED visits. MDCN provides low-acuity 9-1-1 callers the option of on-scene evaluation and treatment. For patients requiring additional resources, but not needing an ED, an alternate destination is considered.

Methods: Patients were screened low acuity by EMS personnel and voluntarily enrolled in MDCN. A questionnaire was given to patients after their visit to assess satisfaction. CRISP, a database for hospital visits in Maryland, was reviewed to assess if patients went to the ED after an MDCN visit.

Results: In 1 year of service, 168 calls were screened, with 144 patients consenting to treatment by the MDCN team. Of enrolled patients: 94 (65%) were treated on the scene, 37 (26%) were transported to an urgent care facility, 1 (0.6%) was transported to their primary care provider for a same-day appointment, and 12 (8.4%) were transported to the ED after further evaluation. Of the 94 patients treated on scene, 3 (3.2%) presented to a local ED in the surrounding area within 72 h. On review, there were no safety issues identified or deficits in the clinical care provided on scene.

Conclusion: This innovative model of on-scene evaluation and treatment can potentially reduce transports, decrease ED wait times, and reduce costs, in an effective and efficient way.