About a quarter of the District’s 911 medical responses are to events that don’t require emergency services and can be treated in primary and urgent care clinics. These events often end up crowding the emergency room and can increase ambulance response times. To address this problem, nurses were placed directly in the 911 call center. The goal is to make sure all callers in need of an ambulance received one, and those who don’t, can speak with the nurse and arrange transportation to primary or urgent care without an ambulance. Through a randomized control trial, we are testing whether the program leads to improved use of emergency rooms, primary and urgent care, 911, ambulances, and prescription drugs.
Why is this issue important in DC?
Patients who do not require 911 emergency services, but call anyway, may be better served in a primary or urgent care clinic. Serving them in an emergency room may lead to worse care than could be achieved through coordinated primary care. Plus, an unnecessary 911 response means the same staff and equipment cannot be used in an emergency.
What did we do?
On April 19, 2018, the District launched a 911 Nurse Triage program, called Right Care, Right Now. For example, if a 911 caller reported a stomach ache, with symptoms of the stomach flu, they would be connected to a nurse in the 911 call center. The nurse would talk to them about their needs, and then decide to send an ambulance or arrange rideshare to a primary or urgent care clinic.
Calls eligible for the Right Care, Right Now program were randomly assigned to either receive the typical 911 response or be connected to the Nurse Triage program.
What have we learned?
The study ended on March 1, 2019 and we are currently analyzing results. We expect to report results in 2020. We will heavily rely on Medicaid billing data which can take months to settle and be accurate.
What comes next?
The findings will inform ongoing policy conversations on improving the District’s 911 response and care coordination.
What happened behind the scenes?
Before launch of the program DC-based activists tweeted concerns about not being informed of new 911 changes. In response, The Lab invited them to discuss the evaluation in person. We invited them to our office and we presented details of the program and study, and engaged with their concerns. From this conversation, we were reminded of the importance of publicly pre-registering evaluations and engaging the community early on when developing new programs.