EMS as a Referral Service

Patient Navigation in the Setting of Unscheduled Care

I used to ask my patients “if they would like to go to the hospital?” Now I ask them “what hospital would you like to go to?” Imagine if we were no longer limited in patient transport destinations to hospitals, but could help navigate patients to the most appropriate care, providing each patient with shorter wait times, stronger care coordination and a reduction in costs. That day may not be too far away.

According to some forward thinkers at HHS and DOT, there is a future where not all patients who call 911 end up at a hospital. A draft white paper sets out an innovative vision for the range of dispositions of patient encounters that is premised on what EMTs and Paramedics do best, triage patients between sick and not sick, as well as provide supportive care until the patient reaches definitive care.

Innovative Triage, Treatment and Transport Strategies:

  1. Triage 911 calls without dispatch of an ambulance,
  2. Treatment  without transport,
  3. Transport to an non-hospital receiving facility (urgent care, primary care, substance abuse counseling),
  4. Transport to a hospital, and, maybe,
  5. Scheduled non-acute assessments and treatments.

Innovation Opportunities in EMS

These strategies are predicated on prospectively being able to determine which disposition is applicable to each patient. Academics at NYU have already put in a lot of work toward this goal with the following analysis.

Billing Algorithm:

  1. Non-Emergent – Care not required within 12 hours
  2. Emergent / Primary Care Treatable – Complaint did not require continuous observation, and no procedures were performed or resources used that are not available in a primary care setting
  3. Emergent ED Care (Preventable / Avoidable) – Visit potentially unnecessary if timely and effective ambulatory care received during episode of illness
  4. Emergent ED Care – Emergency department care was required and ambulatory care could not have prevented condition

ED Utilization Analysis Algorithm

Ultimately, the problem is that diverting non-emergent and primary care treatable patients away from the ED does not produce significant cost savings. These patients still require treatment, albeit this treatment would be at a reduced rate. The greater savings can be achieved by avoiding admissions and improved care coordination. It is not clear yet how EMS can play a role in achieving these objectives.

Regardless, it does not mean that pursuing these strategies is not a worthy goal. Providing more transport options would have a cultural effect on patients and providers and, certainly provide creative flexibility in a currently straitjacketed industry.

As a postscript, this post’s title comes from a Trauma Residence who once told me ambulance services were the best referral services for his/her department.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s