Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments
Abstract
Background. Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods. “Blinded for Peer Review” EMS initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care related patients away from the ED where possible. Using a case-control study design with multiple outcome variables, we describe the program and compare differences in effectiveness measures relative to the control group. Results. During the first 12 months, 5,570 patients received the intervention. We found a 76% decrease in ambulance transports to the ED with the intervention (18% vs. 74%, P<.001). EMS productivity (median time from EMS notification to unit back in service) was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median). There were no statistically significant differences in mortality or patient satisfaction. Conclusions. We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.