By Glenna Murdock, RN, contributor
Managing the escalating cost of health care has inspired creative thinking from the nation’s health care providers, be they hospitals, physicians’ offices, long-term care facilities or emergency services. Everyone is looking at how to help patients in the most cost-efficient way.
The costs of emergency services are of particular concern because those services are often used in place of a primary health care provider by the medically indigent or as a fall-back service for frightened patients when a true medical emergency does not exist.
So how can officials separate the callers with true emergencies from the non-emergency ones—and help the latter find appropriate care? With the help of a qualified tele-nurse.
Cities across the country are investigating programs that would funnel non-emergency 911 calls to nurses who evaluate the caller’s condition and recommend alternative health care resources, thus avoiding the dispatch of an ambulance.
The Richmond Ambulance Authority (RAA) in Virginia has pioneered such a service in the United States, patterned after a similar program in England. In 2004 RAA partnered with the maker of the software that was used in the British tele-nurse program to initiate a pilot program that investigated the feasibility of 911 tele-nursing for the city of Richmond.
During the pilot phase, 911 dispatchers used computer software triage protocol to determine if apparent low-acuity calls could be routed to a nurse. The nurse, after speaking with the patient, then used another software program to find the most appropriate community health care resource for the patient. A nurse would also remain engaged with a caller when an ambulance was dispatched.
“The nurse followed up with the caller and compared the software-suggested disposition data with the actual patient outcomes,” explained Lee Ann Baker, chief administrative officer for what is now known as the Community Health Access Program (CHAP). “The data was screened for the 15 months of the pilot program and it was determined that in every case the outcome would not have been adversely affected had an ambulance not been dispatched. CHAP then went live on March 1, 2006.”
A physician coordinates the program and manages the staff of six part-time RNs who work singly, manning the CHAP phone lines from 7:30 a.m. to 7:30 p.m., seven days per week. If the patient insists upon an ambulance, one is sent. In the majority of cases, however, a dispatch is avoided.
“The nurse informs and advises the caller about available community resources appropriate to the caller’s needs,” said Baker. “The nurse can often direct the caller in self-care or suggest a referral to a free clinic, a mobile dental clinic or a doctor’s office, among other options. If a visit to an urgent care clinic is necessary, we have a contract with a medivan service that will transport the caller to and from urgent care and the cost is still less than dispatching an ambulance.”
Between calls the nurses are proactive, checking in with the most frequent callers, for instance, to ask how they are doing.
“The nurses form relationships with the community,” Baker said, “and look for creative ways to match the needs of callers with resources available within the community. It is important to build awareness and get the community involved.”
Based on Richmond’s success, other cities have shown significant interest in the CHAP initiative, according to Baker. Houston, Texas, recently began a similar program and the city of Philadelphia is being urged by its city controller to do the same.
“Tele-nursing allows better prioritization of emergency responses,” said Philadelphia’s controller, Alan Butkovitz. “Our fire commissioner says that 80 percent of the city’s 220,000 emergency calls each year should not be getting rescue squad response. With tele-nurses handling non-emergency 911 calls, those who have ‘drop-everything’ emergencies will have more rapid responses.”
“It is possible that the use of tele-nurses could save the city as much as $2.5 million per year and save lives,” Butkovitz reported.
Informal telephone triage has been around as long as the telephone itself. One of the first calls made by Alexander Graham Bell was to ask for help with a battery acid burn he’d suffered. Now it appears that tele-nursing will figure prominently in health care as changes are made to optimize services for the country’s burgeoning population.
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