Washington, D.C. has relieved pressure on emergency services by analysing masses of call data. The city figured out that a majority of those ringing the emergency line with low-priority complaints were actually lacking access to transport and medical care. To solve the problem, the city created a new triage line, which diverts these callers to local clinics and provides them with transport to take them there.
Results & Impact
The program is yet to begin, and the city is reluctant to put any targets on a project whose aim is to improve access to care. Washington, D.C. currently has the highest rate of 911 emergency medical services calls per capita in the country, and roughly half of the calls they receive don’t require an emergency response. The pilot program aims to redirect these low priority callers from emergency departments and towards more fitting primary care clinics.
Washington, D.C. Fire and Emergency Medical Services Department, the Lab @DC, Washington, D.C. Department of Health, Washington, D.C. Office on Aging, Medicaid Managed Care Organisations, Washington, D.C. Department of Healthcare Finance, Washington, D.C. Department of Behavioral Health, DC Hospital Association, Washington, D.C. Office of Unified Communications, Executive Office of the Mayor Washington, D.C.
By analysing and linking datasets on 911 callers, the Washington, D.C. Fire and Emergency Medical Services Department (FEMS) discovered that 68% of its emergency calls for low-priority issues came from Medicaid recipients: poorer patients who often have little access to transport. The analysis also showed that a majority of these calls came from areas near primary care clinics. Based on this analysis, FEMS has devised a program to match patients to relevant care. Nurses have been employed to filter low-priority cases from emergency calls as they come in. The nurses direct these patients to their nearest primary care clinic and offer a car service to pick them up and drive them there.
Patients, low-income people, the elderly, city dwellers
Cost & Value
The pilot will cost $1 million for the 2018 financial year. The second year of the program is expected to be slightly more expensive.
Planning for the pilot, beginning October 2017
The project incorporates a number of departments, agencies and non-government contractors within Washington, D.C., so it has been relatively complicated and unwieldy. Officials said that winning funding for the project in the district government budget is a slow process that requires close cooperation with the Mayor’s Office. With so many parties involved, opposition from any one of them can slow or block implementation, officials said. However, by inviting the various stakeholders to planning meetings from the beginning, the project team has been able to build a consensus and progress without significant delays.
Washington, D.C. will reduce the burden on its emergency services after discovering an opportunity hidden within its emergency call data.
By combining datasets, the city discovered that many of those calling 911 with low-priority complaints lacked access to transport and care. Now it is creating a new nurse triage line to filter these callers and match them with carers.
A pilot of the program beginning in October 2018 will see the Washington, D.C. Fire and Emergency Services Department (FEMS) introduce nurses to its existing call response centres. If a patient’s call is defined by the call taker as low-priority it is then forwarded to a qualified nurse. Using their judgement and a computer algorithm which assesses the details of the problem, the nurse will then decide whether the patient requires an emergency response. If not, the patient is directed to a primary care clinic, and a car is sent to pick them up. The program provides patients with care suited to their needs and reduces the burden on Washington, D.C.’s emergency services.
“Washington, D.C. has the highest rate of 911 emergency medical services calls per capita in the country,” said Dr Robert Holman, Medical Director at the Fire and Emergency Medical Services Agency (FEMS). “Roughly half of our calls really don’t need paramedics, and may not even need our emergency services. Many of our calls are quite basic and could be better handled in a clinic setting.”
This prompted officials at FEMS to look for a solution.
“We had to do a lot of data analysis. We derived that 68% of our low-acuity callers are from what we would call a vulnerable population, and have Medicaid,” said Holman.
By mapping this low-acuity caller data across Washington, D.C., Holman and his colleagues were able to see where these low-priority patients were calling from. It emerged that the vast majority of these calls were made in areas in close proximity to health centres and primary care clinics.
“In Washington, D.C. we actually have a very highly developed and mature system of federally qualified health centres that are designed to serve the most vulnerable segments of our population,” said Holman. “We realised that we had a system in place that could handle a diversion of these patients from the emergency room to a more appropriate setting, where they could get comprehensive medical care.”
After identifying the types of callers who make the low-acuity calls, Holman and his colleagues at FEMS were able to tailor their service to respond more fittingly.
“We realised that one of the difficulties for our patients was not their misunderstanding of the 911 system as much as it was a need for transportation for immediate medical care,” said Holman. The solution FEMS came up with was to provide patients with non-emergency medical transport. Working with managed care companies under Medicaid and other private insurances, FEMS has designed a system which sees low-acuity callers picked up within an hour and taken to a clinic. Through this, patients are directed towards the most applicable form of care and pressure is taken off D.C.’s oversubscribed emergency and ambulance services.
FEMS began to look at emergency calls data back in March 2016. Through drawing a number of different datasets together officials at FEMS were able to discover the correlation between low-acuity callers and Medicaid recipients. By plotting their locations on a map, they work out a large proportion of these calls came from locations in close proximity to federally qualified health centres.
Holman then approached Washington, D.C.’s Fire Chief with the nurse triage line idea shortly afterwards, which led into discussions in April 2016 with 26 officials from across D.C.’s government agencies. By the end of August, the number of attendees had grown to 60. The scheme incorporates workers from across Washington, D.C.’s agencies, including The Department of Health, the Office on Ageing, and the city’s new data analysis team based in the Office of the City Administrator’s Office of Performance Management (OPM) the Lab @ DC.
The Lab @ DC was formed in July 2017 and will use data collected as part of daily operations to evaluate the program for success. It will focus on several outcomes during the pilot period: 911 call volume, emergency department use, and primary care clinic use. While officials anticipate the scheme will lead to cost savings, since primary care clinics are less expensive to run than emergency departments, Dr Holman stressed that this wasn’t the priority: “It really is a secondary effect, not a primary effect, whether or not this will change healthcare expenditures. What we’re really trying to do is see ourselves as patient care.”
The trial, set to begin in October, will cost $1 million for the 2018 fiscal year, though Holman anticipates that the costs in subsequent years will be slightly higher. According to Holman, winning funding for the program in the district government budget was difficult, and with so many different parties involved – including private care providers – the process has been slow: “We have to be very mindful of all of the details about this sometimes unwieldy project.”
The program will only apply initially to the lowest acuity callers, but if successful, officials plan to expand it to cover those cases slightly above this benchmark.
(Picture credit: Pixabay)