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Am J Med Qual. 2018 Sep 19:1062860618800582. doi: 10.1177/1062860618800582. [Epub ahead of print]

Making Triage Decisions for the Acute Community Care Program: Paramedics Caring for Urgent Health Problems in Patients' Homes.

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1 Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA.
2 Department of Medicine, Harvard Medical School, Boston, MA.
3 Commonwealth Care Alliance, Boston, MA.
4 Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
5 EasCare LLC, Dorchester, MA.
6 Data Coordinating Center, Boston University, Boston, MA.


The Acute Community Care Program (ACCP) initiative sends specially trained paramedics to evaluate and treat patients with urgent care problems in their residences during evening hours. ACCP safety depends on making appropriate triage decisions from patients' reports during phone calls about whether paramedics could care for patients' urgent needs or whether they require emergency department (ED) services. Furthermore, after ACCP paramedics are on scene, patients may nonetheless need ED care if their urgent health problems are not adequately treated by the paramedic's interventions. To train clinical staff participating in all aspects of ACCP, including these triage decisions, ACCP clinical leaders developed brief vignettes: 27 represented initial ACCP triage decisions and 10 the subsequent decision to send patients to EDs. This report describes findings from an online survey completed by 24 clinical staff involved with ACCP triage. Clinical vignettes could be useful for staff training and quality control in such paramedic initiatives.


case vignettes; emergency services; paramedics; triage; urgent care


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