ET3 Treat in Place Program Implementation in a Large Urban EMS System

In 2019, the Centers for Medicare and Medicaid Services (CMS) announced the Emergency Triage, Treat, and Transport (ET3) Model, an innovative care model aimed at increasing the quality and lowering the cost of emergency service care through telehealth services and alternative destination options for low-acuity cases. New York City (NYC) implemented ET3 protocols to enable broad adoption in the 9-1-1 system. The purpose of this study is to identify the characteristics, disposition of patients and challenges of the ET3 program in a single 9-1-1 emergency medical service (EMS) system.

Retrospective chart review of program data from one urban EMS service in NYC as per the inclusion/exclusion criteria in the local prehospital protocol including 1) rates of patients meeting criteria for an ET3 encounter; 2) rates of acceptance of ET3 telehealth treat-in-place encounters, 3) disposition of cases; 4) rates of return visits within 72 h.

From August 2022-December 2023, 133,646 9-1-1 calls were answered. Of these, 78,911 (59%) were triaged for ET3, of which only 2,130 (3%) met inclusion criteria. Telehealth ET3 encounters were not offered to 1556 (73%). Of the remaining, 524 (92%) refused to participate in ET3 encounters, and 50 (9%) accepted. Of those who accepted, 31 (62%) were treated in place with telehealth, 15 (30%) were transported to the emergency department (ED), and 3 (6%) refused medical attention. Only 4 (13%) of those treated in place subsequently encountered an ED within 72 h.

The NYC EMS launch of the ET3 pilot was met with very low acceptance from eligible participants. The pilot helped to identify implementation challenges including proper personnel training, public outreach and awareness, and technological barriers. There is promise in avoiding transportation to the ED among those willing to participate with an even smaller rate of those requiring further unscheduled acute care. Our findings highlight limited offerings of ET3 encounters, and poor patient participation once offered. Further initiatives may consider workflow improvements and education to the public to improve willingness to participate.