DC Department of Healthcare Finance
DC Office of Unified Communications
About one in four of the DC’s 911 medical calls don’t require emergency services and could be treated in primary and urgent care clinics. They often fill up emergency rooms and slow down ambulance responses across DC. “Right Care, Right Now”—a 911 Nurse Triage program—places nurses in the 911 call center. The goal is to make sure that callers who need an ambulance receive one, while those who do not can speak with the nurse. The nurse can arrange transportation to primary or urgent care. Through a randomized control trial, we found program improves use of ambulance services, emergency rooms, and primary care in the 24 hours after the 911 call.
A Right Care, Right Now nurse on duty. (Credit: DC Office of Unified Communications)
Why is this issue important in DC?
Callers 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 emergencies.
What did we do?
From April 2018 to March 2019, the District piloted a 911 Nurse Triage program, called Right Care, Right Now. In one example, if a 911 caller reported a stomachache, 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.
During the pilot period, eligible calls were randomly assigned to either receive the typical 911 response or be connected to the Nurse Triage program. This randomized setup allowed us to measure the impact of the program on ambulance, emergency department, and primary care use.
What have we learned?
For callers connected to the Nurse Triage program, we found that ambulance dispatches fell by 41 percentage points and ambulance transports fell by 28 percentage points. For those callers who receive Medicaid benefits (about half of callers), emergency department use fell from 29.5% to 25.1% and primary care use increased from 2.5% to 8.2%. But, six months after the 911 call, there was no difference in emergency or primary care utilization.
“Our calls to 911 are wildly out of proportion to our population, which compromises emergency services for everyone. We can’t wait any longer to fix this problem.”
What comes next?
When the program started, policymakers said that decreases in emergency department or ambulance utilization or increases in primary care utilizations would be considered successes. The program met those goals.
The program now operates 24 hours a day and as of August 2022, nurses have triaged more than 52,000 calls through the program. FEMS estimates that the program has referred more than 20,000 911 calls to resources other than the Emergency Department.
The co-authors of the preliminary report plan to conduct a detailed cost analysis of the program and evaluate its effects on other outcomes.
What happened behind the scenes?
Before launch of the program, DC-based activists were concerned that they were not informed of changes to the 911 system. The Lab invited them to discuss the evaluation in person. We invited them to our office, and we presented details of the program and discussed their concerns. This conversation reminded us of the importance of publicly pre-registering evaluations and engaging the community early in the process.