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

Area of Science:

• Emergency Medical Services
• Health Services Research
• Public Health

Background:

• The Centers for Medicare and Medicaid Services (CMS) introduced the Emergency Triage, Treat, and Transport (ET3) Model in 2019.
• ET3 aims to improve emergency care quality and reduce costs via telehealth and alternative destinations for low-acuity cases.
• New York City (NYC) implemented ET3 protocols within its 9-1-1 system to encourage widespread adoption.

Purpose of the Study:

• To evaluate the characteristics and patient disposition within NYC's 9-1-1 emergency medical service (EMS) system under the ET3 program.
• To identify challenges encountered during the implementation and operation of the ET3 model in a large urban EMS setting.

Main Methods:

• A retrospective chart review was conducted on program data from a single urban EMS service in NYC.
• Data analysis focused on patient eligibility for ET3 encounters, acceptance rates for telehealth treat-in-place options, patient disposition, and 72-hour return visit rates.

Main Results:

• Out of 133,646 9-1-1 calls, 78,911 (59%) were triaged for ET3, with only 2,130 (3%) meeting inclusion criteria.
• Telehealth ET3 encounters were offered to only 524 patients (25% of eligible), with 50 (9%) accepting and 31 (62%) treated in place.
• Of those treated in place, only 4 (13%) required subsequent emergency department visits within 72 hours.

Conclusions:

• The ET3 pilot in NYC experienced very low acceptance rates among eligible participants.
• Key implementation challenges identified include personnel training, public awareness, and technological barriers.
• While ET3 shows promise in reducing ED transports for willing participants, further improvements in workflow and public education are needed to enhance participation.