Idea #3: Triage nurses answer 911 calls


Our guest: Dr. Robert Holman, the medical director of the Washington D.C.’s fire and emergency medical services unit.

911 is for emergencies, but clearly not everyone has gotten that particular memo. There’s not much hard data available on this, but evidence suggests between one quarter and one half of calls to first responders prove to be something quite a bit less than four-alarm urgent – low acuity, in industry parlance. Often, it’s just somebody suffering from a troubling but non-emergency medical problem and a general difficulty navigating the healthcare system. Maybe they’re old, confused, disabled, uninsured, or just desperate. Maybe, despite their best efforts, they haven’t been able to book a normal primary care appointment. Or maybe their symptoms, often arising from poorly managed diabetes or hypertension, seem a lot more urgent than they actually are.

Whatever the reason, they phone up 911, which can offer an expensive ambulance ride to an even-more-expensive emergency room and not much else. All too often, it’s the medical equivalent of cutting butter with a chainsaw.

But in a handful of cities, that is starting to change. Mesa, Arizona, Louisville, Kentucky and now even Washington, DC, are among the jurisdictions trying to divert those non-emergency calls to a crack team of nurses, paramedics and fixers, backed by a collaboration of city departments. Their job is to triage over the phone, give out information, and help out with non-ambulance transportation logistics. The overall goal is to use every low-cost trick in the book to nudge low acuity patients into normal low acuity channels of primary care.

Going the extra mile to help patients get better, more comprehensive care and avoid long waits in emergency rooms, all the while possibly saving piles of money normally spent on specialists and ambulance rides. It’s today’s idea so crazy, it just might work.

MANY THANKS THIS WEEK TODr. Chrysanthi Hatzimasoura and Sam Quinney of The Lab @ DC, a team of scientists that studies new and interesting ways to deliver public services.



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