The following is a summary of “DC’s New 911 Nurse Triage Program” from the October issue of Annals of Emergency Medicine.
In April, triage nurses began working with the 911 call center in Washington, D.C., responding to callers with milder symptoms and, when appropriate, directing them away from emergency departments to urgent care centers, walk-in clinics, and primary care physicians. This new initiative was designed to ease the load on D.C.’s overburdened emergency departments and ambulance corps and to help establish a better pattern of care for patients.
At least six other similar initiatives are currently operating in the United States; D.C. consulted with a few of those programs before launching its effort. D.C. was able to get health insurers to agree to provide nonemergency medical transportation on a same-day basis when directed to do so by triage nurses, thereby overcoming what might have been a significant hurdle to implementation.
Strategies like D.C.’s seem to save payers a bundle. Reno, Nevada, calculated that between October 2013 and June 2016, its nurse triage program reduced medical care costs by nearly $6 million. So why aren’t more jurisdictions in the United States trying out similar initiatives? One argument is that most entities that oversee emergency medical services get paid per ambulance ride rather than per patient. Therefore, there isn’t much incentive to change. Another critic complains that if you were to take a nuanced look at the entire course of treatment, nurse triage programs, in total, would likely end up costing more. What’s more, nurse triage programs represent a perceived risk that patients in need of urgent care might be diverted erroneously. Although programs in places like Reno, Las Vegas, and Fort Worth, Texas, report that they’ve had no adverse outcomes, there are no randomized studies on 911-based triage nurses fielding low-acuity emergency calls.
Ms. Kelly is a special contributor to Annals News & Perspective.