New 911 Program Could Ease Crowded ERs
Merrille Noe, left, instructs fellow EMS staff member Rick Roller in Louisville's program to reduce ambulance runs and ER crowding, as Amy Pierce, right and Kim Wright watch. [AP]
June 01, 2010
LOUISVILLE – Hoping to ease crowded emergency rooms and trim ambulance runs, Louisville Metro Emergency Medical Services (EMS) has launched a program that aims to screen low-priority calls and divert patients from hospitals into more appropriate health care.
Under the program, which started April 19, a small number of the lowest priority calls — such as those for an earache or a stomachache — are being turned over to a nurse who is able to spend time with the patient on the phone to figure out appropriate treatment, which may not include a trip to an emergency room in an ambulance.
“We’re trying to challenge the way things are traditionally done,” says Neal Richmond, an emergency room physician and Louisville Metro EMS director. “Let’s find these people better care.”
The program, which is among the first of its kind in the nation, is widely used in the United Kingdom and Australia, says Jeff Clawson, medical director for the National Academies of Emergency Dispatch.
Though a handful of cities have explored similar programs, only Louisville and Richmond, Va., which piloted the program, are fully using it in EMS systems, he says.
Clawson says that if the system is used carefully, it can be a powerful way to “preserve precious resources” while still getting patients the care they need. “The time is here for this.”
Most patients calling 911 won’t notice much of a difference, because all calls will continue to be screened through the automated protocol system already in place, says Kristen Miller, chief of staff for Louisville Metro EMS. On average, the Louisville system handles about 230 to 250 calls a day, she says.
But for an estimated 10 to 15 calls a day — the ones classified as the lowest risk — callers are getting some additional screening from a registered nurse or nurse practitioner. That way, the nurse can better assess whether the patient’s condition is serious or does not require emergency care. Most of the calls so far have been about leg pain, abdominal pain and wound care.
The nurse can make alternative recommendations and even help the patient make an appointment with a doctor or clinic, Miller says. For patients who don’t have a regular doctor, the system has identified physicians and clinics that will agree to take new patients, Miller says. “We’re trying to help people get a foot in the door of the health care system.”
Not sending a patient to the emergency room could result in better follow-up for the patient, Miller says. And ultimately, that will lead to better long-term care.
In the first week of the program, a handful of patients each day were redirected to immediate-care centers, and some were given non-ambulance transport, Miller says. She adds that nurses are being extra conservative in the early days and are sending ambulances if there is any question about what’s needed.
For Darlene Wilcoxson, the new program was just what she needed. Wilcoxson has a regular doctor, but when she started feeling pain in her legs that made it difficult to walk, she decided to call 911. Wilcoxson, 61, spoke to a nurse and was then taken by a private transportation company called Wheels to an immediate-care center, and an emergency appointment was made for her with her own doctor.
“I didn’t know what else to do but call an ambulance,” she says, adding that she was happy not to go to the emergency room. “I was waited on real quick and I was out real quick.” The doctors were able to rule out a blood clot, which had been her fear.
For more than a year, EMS has worked with the local health systems and emergency dispatchers to set up the program, which costs about $100,000. Of that, $50,000 came from a grant from HMO Passport Health Plan, the rest from the city budget.
The program operates just four days a week during regular business hours for now, Miller says. It will include intensive follow-up with patients and physicians to ensure no one falls through the cracks.
Michael Needleman, a family physician who is interested in participating in the program, says that while he believes there will be kinks to work out, the program has tremendous promise to help ease an overburdened system and reduce costs.
Crowding in emergency rooms has been a problem in many communities in recent years. A 2006 study by the Institute of Medicine, some of the most recent data available, showed that demand for emergency room care nationwide grew by 26% from 1993 to 2003.
For the past 26 years, Jackie Lanham has worked as a registered nurse, including stints in the emergency room, and says that when emergency rooms fill with patients who have non-emergent ailments, such as colds or stomach upset, it takes away from time staff can spend on more critical patients. But often, she says, that occurs because patients don’t have, or don’t know of, a better option.
The new program is “very promising,” Lanham says. “It’s something we’ve needed for a long time.”
Jerry Overton, former chief of the Richmond EMS system, says there is no question this is the future of medical dispatching.
“Nobody falls through the cracks,” Overton says. “We have to be headed in this direction.”