IHI ID 18 Development of an EMS protocol to systematically reduce preventable ambulance responses

BackgroundRequests for Emergency Medical Services (EMS) are generated by patients, caregivers, bystanders, or allied agencies. It was theorized that many requests initiated by allied agencies were preventable, resulting in response cancellations, patient refusals, or transport for non-life threatening conditions.ObjectivesThe objective of this study was to reduce preventable responses to requests initiated by allied agencies by 37%.MethodsThis study was conducted in Charlotte, NC from 1/27/2017 to 8/7/2018 with a single EMS agency and a first responder service who responds to most EMS requests. A descriptive analysis identified the number of requests initiated by allied agencies and categorized the outcome of the response (patient transport, refusal, or cancellation). A driver diagram and PDSA ramps identified a promising change concept: delayed EMS dispatch to eligible requests for service (figure 1). Exclusion criteria were developed through simulated and live PDSA testing, and were as follows: patients matching specific problem natures under the Medical Priority Dispatch system; or, patients exhibiting the following symptoms: altered level of consciousness, difficulty breathing, serious hemorrhage, and/or chest pain. Improvement and sustainability were monitored using p-charts.Abstract IHI ID 18 Figure 1ResultsOf the 5498 requests for service received from allied agencies, 77.3% (n=4252) were received from the police department and 53.0% (n=2913) were preventable. The delayed dispatch protocol was implemented with an 18.3% reduction in responses (figure 2).Abstract IHI ID 18 Figure 2ConclusionsThe delayed dispatch protocol achieved a stable, safe reduction of responses and allowed ambulances to remain in position for life-threatening calls. Future work will further reduce immediate dispatch for eligible calls.