Evaluating the Need for Advanced Practice Providers in the Pre-Hospital Setting

Abstract

Emergency Departments (ED) have become overburdened from low acuity patients which can lead to increased burnout for medical staff in both the hospital and prehospital setting (Murphy et al., 2020; Osliso et al., 2022). With the implementation of Advanced Practice Providers (APPs) in the field, a true “treat and street” protocol can be practiced. The communities benefit from having access to an Emergency Medicine Provider as well as continued care via the community paramedic (Jacobsohn et al., 2022). The healthcare system will benefit due to having less patients needing to use EMS and ED resources (Joy et al., 2019). Allowing APPs to respond to low acuity calls in the pre-hospital setting has the potential to positively impact all aspects of emergency medical services at the pre-hospital setting (Mechem et al., 2019). By implementing an Advanced Practice Provider in the Emergency pre-hospital setting, evidence shows that patients receive the care they are seeking, while also relieving the burden on EMS (Schmiedhofer et al., 2016). Setting is in Greenville, North Carolina. Patients calling the 911 system to seek care in the Emergency Department (ED) via Greenville Fire & Rescue (GFR) who provide EMS and transport to the Level One Trauma Center. Participants: All Adults aged ? 18yrs old, calling Greenville Fire & Rescue from 02/2023-02/2024 for EMS and labeled as Low Acuity. Intervention: Request for 911 call data from GFR was placed by project lead. Data for patients that met inclusion criteria was received for 12 months from 2023-2024. This information was consolidated by low acuity complaints; selecting patients that did not receive intervention from EMS and were transported to the ED. Through descriptive data analysis of 14,245 calls annually from 2023-2024, a random 30 day sample was obtained where 142 non-emergent, low acuity patients were transported to the ED with no interventions from EMS. Through descriptive data analysis of 14,245 calls annually, a random month sample was obtained where 142 non-emergent, low acuity calls were transported to the hospital with no interventions from EMS. Therefore, those 142 calls, with APP intervention there could have been an opportunity to treat and release the patient from the scene instead of transporting to the Emergency Department. Descriptive statistic analysis of the EMS data from Greenville Fire & Rescue reveals 46% of the calls over 12 months were low acuity calls. Further investigation revealed that out of 30 randomly selected consecutive days, 142 calls were low acuity calls that were also transported to the ED, non-emergently. These findings demonstrate a need for APPs in the pre-hospital setting to care for low acuity EMS calls, thereby meeting overall aim of this project. Furthermore, while patient outcomes were not measured in the project, the findings highlight a potential mismatch between patient needs and resource utilization. Limitations: No patient outcome data was collected. Classification of acuity was based on EMS triage maybe subject to variability. Data analysis focused on descriptive findings; casual relationships or effectiveness of interventions were not assessed. These results suggest an opportunity to explore the implementation of a “treat and street” model in which Advanced Practice Providers (APPs) are integrated into the pre-hospital setting to evaluate and manage low-acuity cases on site. While this project did not directly measure patient outcomes, system savings or the impact of APPs, the data highlight a pattern of potentially avoidable transports. This trend contributes to increased demand on EMS personnel and adds strain to Emergency Department resources. Based on these observations, incorporating APPs to manage low-acuity patients.