88 Comparison of Emergency Medical Services and Emergency Department Providers’ Clinical Impressions and Time to Disposition

It is expected of emergency medical services (EMS) providers to correctly interpret available clinical data and formulate a clinical impression that coincides with a standing order treatment guideline/protocol or to contact medical control for orders. It is expected that if the EMS providers’ impression is accurate necessary treatments will be provided in the out-of-hospital setting. The purpose of this study was to determine if agreement between EMS and emergency department (ED) providers impression impacts the patients’ ED time to disposition. A convenience-based survey was conducted between March and August 2014 during the hours of 8am to 12am when research associates were available at an academic level 1 trauma center emergency department. A chart review was performed to determine the ED provider’s final impression and time to disposition. Surveys were reviewed by a senior emergency medicine resident physician to determine if the EMS and ED provider impressions agreed. Two hundred forty-eight patient encounters representing patients transported by 40 EMS agencies in the central New York region were collected. The mean age of patients was 43.6 (± 26) years and 50% were males. The EMS and ED providers’ impression agreement was 85.9%. There was no statistical difference in the time to disposition with respect to impression agreement. Among the 5 EMS services that were surveyed the most, impression agreement ranged from 76.5-93.3% and were not statistically different. EMS providers surveyed were 78 EMT-Basic/Level 1 (31.5%), 1 EMT-Intermediate/Level 2 (0.4%), 16 EMT-Critical Care/Level 3 (6.5%), 153 EMT-Paramedic/Level 4 (61.7%). There was no statistical difference in the distribution of levels of providers by whether or not EMS and ED provider impressions were in agreement. The EMS providers averaged 12 (± 10) years in EMS and it was not a predictor of EMS and ED provider impression agreement. There was no statistical difference in the agreement of EMS and ED provider’s impression between pediatric (0-19 years, 89.8%) and adult (>19 years, 84.6%). Finally, amongst the group of patients where there was disagreement in impression, there was a greater percent of women in the group, 71.4% (P = .006). From our available data, we were not able to show a statistical difference in time to disposition with regards to impression agreement. The findings suggest that the accuracy of diagnostic impression by EMS providers in this cohort is affected by patient sex. This may reflect an area for further research and/or education.