The Effect of Paramedics in Emergency Department Triage on Ambulance Patient Offload Times A Retrospective Observational Study

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Published: Apr 3, 2024
DOI: https://doi.org/10.56068/VAPF4488
Keywords:
ambulance offload delay, delivery interval, scope of practice, EMS, emergency medical services, paramedicine

Main Article Content

Chris Kuhner, MD
Maimonides Medical Center
John Su, MD
Maimonides Medical Center
Eric Quinn, MD
Maimonides Medical Center
https://orcid.org/0000-0001-7261-7235
Jennifer Wolin, MD
Maimonides Medical Center
Joshua Kimbrell, NRP, FP-C
Department of Pre-Hospital Care, Jamaica Hospital Medical Center
https://orcid.org/0009-0006-0292-5586
Matt Friedman, MD
Maimonides Medical Center
David Lobel, MD
Maimonides Medical Center
Eitan Dickman, MD
Maimonides Medical Center
David Eng, MD
Maimonides Medical Center

Abstract

Background: Emergency Department (ED) overcrowding limits patient care in the prehospital and hospital system. A program was implemented to decrease the time to patient handoff from EMS arrival to ED staff, also known as the delivery interval and total turnaround interval. Paramedics were added to the ED ambulance triage staff to receive verbal reports and perform certain tasks done traditionally by nurses. We hypothesized adding paramedics to the ED triage process would reduce delivery interval times and total turnaround times. Methods: This was a retrospective observational study comparing delivery and turnaround intervals for patients brought to the ED by ambulance, before and after the addition of a paramedic in triage. The study period included all adult ED patients brought in by ambulance between 11 AM and 11 PM. Pediatric patients (<21 years old), direct-to-inpatient interfacility transfers, and critical patients requiring immediate care in the resuscitation area and thus bypassing normal triage processes were excluded. The data was analyzed with two-sample t-tests with a confidence interval of a = 0.05. Results: Delivery interval pre-implementation of the program was 15:48 minutes (95% CI [15:28, 16:09]) compared to 14:04 minutes (95% CI [13:44, 14:25]) post-implementation. The mean turnaround interval pre-implementation was 35:21 minutes (95% CI [35:01, 35:42]) and 36:04 minutes (95% CI [35:40, 36:29]) post-implementation. The mean difference for the delivery interval was shortened by 01:44 minutes (p<0.0001; 95% CI [01:15, 02:13]). The mean turnaround interval increased by 00:43 seconds (p<0.01; 95% CI [00:11, 01:16]). Conclusion: Staffing a paramedic in ED triage decreased delivery interval by 1:44 minutes but did not affect ambulance turnaround times. Further research is needed to determine if the decrease in delivery interval improved patient outcomes and ways to translate the time saved in the delivery interval to total turnaround times.

Article Details

How to Cite
Kuhner, C., Su, J., Quinn, E., Wolin, J., Kimbrell, J., Friedman, M., … Eng, D. (2024). The Effect of Paramedics in Emergency Department Triage on Ambulance Patient Offload Times: A Retrospective Observational Study. International Journal of Paramedicine, (6), 18–28. https://doi.org/10.56068/VAPF4488
Issue
No. 6 (2024): April - June, 2024
Section
Research Reports
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Author Biographies

Chris Kuhner, MD, Maimonides Medical Center

Chris Kuhner MD is an Emergency Medicine Resident and one of the Chief Residents at Maimonides Medical Center in Brooklyn, New York. He is interested in pursuing a career in EMS. Other interests include QI, resident wellness, and mentorship.

John Su, MD, Maimonides Medical Center

John Su MD is the corresponding and second author. He is an Emergency Medicine Resident entering his third year of residency at Maimonides Medical Center in Brooklyn, New York. He graduated medical school from Ohio State. His focus as a physician has always been on mentorship, wellness, and incorporating the latest in evidence based medicine into his patient care.

Eric Quinn, MD, Maimonides Medical Center

Eric Quinn MD is an EMS Physician and EM Attending Physician at Maimonides Medical Center (4802 10th Avenue, Brooklyn NY, 11219). He graduated from Drexel University College of Medicine and completed his residency and chief residency in Emergency Medicine at Maimonides Medical Center. He completed his EMS fellowship training at Cooper University Hospital. His interests lie in medical education, system improvement, and continuing to push the boundaries of prehospital care.

Jennifer Wolin, MD, Maimonides Medical Center

Jennifer Wolin MD is a third year Emergency Medicine Resident at Maimonides Medical Center in Brooklyn, New York. She is interested in pursuing a career in EMS with an interest in mass gathering medicine and prehospital field response.

Joshua Kimbrell, NRP, FP-C, Department of Pre-Hospital Care, Jamaica Hospital Medical Center

Joshua Kimprell NRP, FP-C is a NYC paramedic. He is interested in quality improvement and recently was the recipient of NAEMSP’s Quality & Safety Award.

Matt Friedman, MD, Maimonides Medical Center

Matt Friedman MD is an Emergency Medicine Attending Physician, EMS Fellowship Director, and Director of Event Medicine at Maimonides Medical Center in Brooklyn, New York. He completed his emergency medicine residency at Mt. Sinai before moving on to complete an EMS fellowship at the Fire Department of New York, one of the largest EMS systems in the world. He is both involved in bedside clinical teaching and bringing the world of EMS and Event Medicine to the Maimonides Emergency Medicine Residency.

David Lobel, MD, Maimonides Medical Center

David Lobel MD is an Emergency Medicine Attending Physician and EMS Medical Director at Maimonides Medical Center in Brooklyn, New York. He has been at Maimonides Medical Center for the past two decades and was the EMS medical director for the majority of his time at Maimonides Medical Center. He has grown the size and scope of the EMS department significantly during his tenure as Medical Director.

Eitan Dickman, MD, Maimonides Medical Center

Eitan Dickman MD, is the executive vice chair and medical director of the department of emergency medicine at Maimonides Medical Center in Brooklyn. He served as the ultrasound fellowship director from 2008 to 2012 and the director of the ultrasound division at Maimonides from 2007 to 2018, which became a nationally-recognized emergency ultrasound program under his leadership.

David Eng, MD, Maimonides Medical Center

David Eng MD is an Emergency Medicine Attending Physician and Assistant EMS Medical Director at Maimonides Medical Center, as well as Clinical Assistant Professor of Emergency Medicine at SUNY Downstate College of Medicine, both in Brooklyn, NY. In these roles, he hopes to bridge the gaps in transitioning patient care from out-of-hospital to in-hospital settings. His interests include resident and EMS education, emergency preparedness and disaster management, mass gathering medicine, and his dog.

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