Reducing Emergency Medical Services (EMS) Usage as Interfacility Transport for Patients Presenting with Chest Pain

Background: Acute coronary syndrome (ACS) is a cannot miss diagnosis. The gold standard workup for this requires serial troponin biomarker evaluation over a period of hours. Traditionally, many of these patients required telemetry while being evaluated in this fashion, however high-quality literature suggesting that low risk patients do not require ongoing continuous cardiac monitoring. Further to this, it was found locally that over 70% of patients presenting with chest pain to our local high volume urgent care undergoing a cardiac work-up were transferred to the main hospital for this via emergency medical services (EMS). We felt this intersection of patient care and medical services could be streamlined to reduce critical resource utilization. Objective: The aim of this study is to reduce the usage of EMS for transport of chest pain patients from the urgent care to the main hospital by 25% over a 3- month period. Methods: This study was conducted as an uncontrolled before-after interrupted time series design. Comprehensive data drilldown was performed through chart review and structured clinical practise evaluation. This led to the creation of an evidence-based safe-for-self-transport tool to be applied in this patient population. The primary outcome measure was the proportion of patients transported via EMS with main balancing measures being proportion of self-transported patients admitted to hospital and time to troponin blood draw in self-transported patients. Results: The education and the newly developed transport tool resulted in a sustained shift below the previous baseline system mean control limit, indicating a significant reduction in EMS usage for patient transport. The overall reduction in usage was 30%. No change in balancing (safety) measures was identified post implementation. Conclusions: EMS remains a finite resource within many Canadian health regions. The results of this study show that by focusing on a cardinal emergency department presentation like chest pain, adapting evidence-based practise through quality improvement methodologies can result in a significant sustained reduction of EMS utilization.