UCSF

Background

Anticipating an increased utilization of healthcare facilities during the COVID-19 surge, the San Francisco Department of Public Health developed a plan to deploy neighborhood-based Field Care Clinics (FCCs) that would decompress emergency departments by serving patients with low acuity complaints. These clinics would receive patients directly from the Emergency Medical Services (EMS) system. Transports were initiated by a paramedic-driven protocol, originally by EMS crews and later by the Centralized Ambulance Destination Determination (CADDiE) System. In this study, we evaluated the outcomes of EMS patients who were transported to the FCC, specifically as to whether they required subsequent transfer to the emergency department.

Methods

We performed a retrospective study of all patients transported to the Bayview-Hunters Point (BHP) neighborhood FCC by EMS between April 11^th, 2020, and December 16^th, 2020. Descriptive statistics and Chi-Square Tests were used to analyze patient data.

Results

In total, 35 patients (20 men, 15 women, average age of 50.9 years) were transported to the FCC. Of these, 16 were Black/African American, 7 were White, 3 were Asian, with 9 identifying as of other races and 9 of Hispanic ethnicity. Twenty-three of these transports resulted from a CADDiE recommendation. Approximately half (n=20) of calls originated within the BHP neighborhood. The most frequent patient complaint was "Pain." Of patients transported to the FCC, 23 were treated and discharged. The 12 remaining patients required hospital transfer, with 3 being discharged after receiving treatment in the emergency department and 9 requiring hospital admission, psychiatric, or sobering services. The likelihood of hospital transfer did not significantly vary by sex (p=0.41), 9-1-1 call origination relative to BHP neighborhood (p=0.92), or CADDiE recommendation (p=0.51).

Conclusion

Three-fourths of patients who required subsequent hospital transfer were admitted or required specialized services, suggesting that the FCC was viable for managing low acuity conditions. However, the underutilization of the FCC by EMS as a transport destination and a high hospital transfer rate indicates training and protocol refinement opportunities. Despite the small cohort size, this study demonstrates that an FCC alternative care site can act as a viable source for urgent and emergency care during a pandemic.