National Public Radio (NPR)
All Things Considered - Reporter: Selena Simmons-Duffin
Can Triage Nurses Help Prevent 911 Overload?
April 19, 2018
AILSA CHANG, HOST: Washington, D.C., has one of the highest rates of 911 calls in the country, and 1 in 4 of them are not for real emergencies. They're for twisted ankles or coughs, rashes, that kind of thing. So D.C. is rolling out a new program today. A team of triage nurses will now be stationed right next to 911 dispatchers. The idea is to divert non-emergency medical calls to a clinic instead of the emergency room. NPR's Selena Simmons-Duffin explains.
SELENA SIMMONS-DUFFIN, BYLINE: You know when you go to the ER and you first sit down with a triage nurse who talks through your symptoms, takes your vitals and gauges how serious your issue is? As of today, that's happening for D.C. 911 callers over the phone.
OGECHI UKACHU: I understand that you're calling about a sore throat. Tell me a little bit...
SIMMONS-DUFFIN: So this call is part of the training for these new telephone triage nurses. Ogechi Ukachu clicks through a series of questions.
UKACHU: Are you having any difficulty breathing or catching your breath?
UNIDENTIFIED PERSON: No.
SIMMONS-DUFFIN: At the end, the computer program puts out a level of acuity, how serious it is. If it's not an emergency...
UKACHU: I'm going to recommend that you be seen at a clinic today.
SIMMONS-DUFFIN: On her computer, Ukachu can see whether the caller already has a relationship with a clinic or if there's one nearby, and she can see the appointment schedule for the day and slot that person in.
UKACHU: All right. It looks like the clinic has an opening today at 10 a.m. I would like to coordinate a ride to and from the visit.
SIMMONS-DUFFIN: Instead of an ambulance, a Lyft - really. The triage nurses can coordinate free Lyft rides for Medicaid patients. This is key since many people who call 911 just have a hard time getting to the doctor. There are a lot of moving parts. It's taken two years, dozens of staff, city health agencies, 22 primary care clinics, contractors, unions, all overseen by D.C. Fire and EMS. Now that the launch is here...
ROBERT HOLMAN: We're very scared. No, (laughter) we're very excited. And of course we all have butterflies in our stomach.
SIMMONS-DUFFIN: That's Dr. Robert Holman, the agency's medical director. He had the idea when he first started two years ago. He looked at the city's 911 call data and saw over a hundred calls every day for basic medical issues.
HOLMAN: And I simply asked a question - wouldn't this be simply better evaluated using a triage nurse?
SIMMONS-DUFFIN: Holman says other cities across the country have tried similar programs - Louisville, Reno, Dallas, Fort Worth. But he says this is uniquely ambitious in scale and how it's embedded within the 911 dispatch system. The hope is that the triage line will save the city and insurers money since ambulances and ERs are the most expensive way to deliver care. Ambulance wait times should go down, and so should ER overcrowding. And Holman argues the patients will benefit, too. For example, he mentioned someone he saw when he worked in a D.C. walk-in clinic. She had a bladder infection.
HOLMAN: And she mentioned that she had had a bladder infection quite recently that was treated easily in an emergency department nearby.
SIMMONS-DUFFIN: If she'd gone to the ER this time, she would've just gotten antibiotics again. But Holman checked the patient's vitals and talked to her. Her blood glucose levels were through the roof. She was depressed and had stopped taking her diabetes medication.
HOLMAN: We could actually offer her treatment of her behavioral health problem as well as treatment of her diabetes in addition to her bladder infection.
SIMMONS-DUFFIN: This is Holman's pitch - getting a primary care visit is a service to D.C. residents looking for medical help. But there are delicate issues here. There have been a few high-profile cases of patients dying waiting for ambulances. Residents might feel like they're being denied something when they're in need.
HOLMAN: Thank you very much. I really appreciate the opportunity...
SIMMONS-DUFFIN: So Holman and his colleagues have crisscrossed the district, going to community meetings and neighborhood associations, talking to residents. This one is in a neighborhood called LeDroit Park.
LOIS WILEY: Well, suppose I say, I don't want to talk to the nurse; I want to go to the hospital 'cause I'm in severe pain.
HOLMAN: Right. So what we're...
SIMMONS-DUFFIN: Lois Wiley, a longtime LeDroit Park resident, is skeptical.
HOLMAN: So it's appropriate to your problem. If you call with a sore throat, we're not taking you to the emergency department.
WILEY: Oh, yes, you are.
SIMMONS-DUFFIN: Oh, yes, you are, she says. The city is treading carefully. It will measure how well this is working, including surveying everyone who gets sent to a clinic instead of the ER. Cities all over the country will be watching closely to see whether the program really does improve ambulance response time, ER overcrowding and the problem of getting patients in to see the right kind of doctor. Selena Simmons-Duffin, NPR News, Washington.
CHANG: This story is part of a reporting partnership with Kaiser Health News.