Iterative Development of a Low Acuity EMS Triage Protocol to Identify Patients Appropriate for Treatment at an Urgent Care Facility.

Abstract Despite studies suggesting that 15% of patients treated by Emergency Medical Services (EMS) can be effectively managed at alternate destinations, most patients continue to be transported to an Emergency Department (ED). As reliable triage algorithms are lacking, we studied and iterated upon a locally developed protocol to help identify EMS patients that might be appropriate to receive care in an urgent care center (UCC). Eligible patients were those that arrived by 911 EMS and were triaged with an Emergency Severity Index (ESI) of 4 (less urgent) or 5 (non­urgent) from July to August of 2014. Prehospital data was used to determine if patients met protocol selection criteria. In-hospital data such as ED disposition, use of advanced diagnostics and interventions was also gathered. Three independent, blinded physicians determined if cases were appropriate for treatment at an UCC. In this retrospective cohort analysis of 273 low acuity ED patients, 121 (44.32%) patients met protocol selection criteria with 102 (84.30%) being determined to be appropriate for urgent care. Meanwhile, out of 152 patients that did not meet selection criteria, 84 (55.26%) were felt to be treatable at an UCC while the remaining 68 (44.74%) were not. The resulting sensitivity of the alternative destination protocol was 54.8% with a specificity of 78.2%. The positive predictive value was 84.3% and negative predictive value was 44.7%. This was a promising step towards the development of a standardized triage protocol for EMS transport of low acuity patients to alternate destinations, though further study is needed.