Although the Houston Fire Department receives approximately 800 to 900 911 calls a day, a fair number of calls are for non-emergency reasons. “People call because they ran out of medications, stubbed their toe, or need a ride to the hospital,” said Michael Gonzalez, MD, FACEP, FAAEM, associate medical director with the Houston Fire Department.
But now a new program implemented last December, Project ETHAN (Emergency TeleHealth and Navigation), is reducing the number of unnecessary trips to the emergency department by using technology that allows emergency physicians to communicate with patients in their homes.
Dr. Gonzalez, program director of Project ETHAN, said that when emergency responders arrive at the scene, they perform a standard assessment of the patient. If they suspect the patient does have a medical need, the patient will talk to an emergency physician via a real-time video-enabled call on a computer tablet that crews also use for electronic medical records.
“The emergency physician will do a quick interview with the patient and collect the same information that he or she would gather in the emergency room,” Dr. Gonzalez said. “Physicians can instruct paramedics to listen to a patient’s lung or to show a stubbed toe, for example, and determine if the patient needs to be taken to the hospital.”
Nuts and Bolts
A team of 14 emergency physicians is employed part-time by Houston’s fire department to work on Project ETHAN. Dr. Gonzalez pointed out that this is not traditional telemedicine but rather telehealth: physicians don’t diagnose or treat but instead see if they can match a patient appropriately to the level of care required.
If the patient does not need transport via ambulance but a clinic visit is warranted, the doctor will set up the appointment and arrange for a free round-trip cab ride for the patient.
“We want to make sure the patient’s need gets addressed,” Dr. Gonzalez said.
“Project ETHAN is a real example of what can happen when public and private entities partner to solve complex programs.” —Michael Gonzalez, MD, FACEP, FAAEM
The program was designed to see if the fire department could safely triage low-acuity patients to appropriate health care settings, thereby making emergency vehicles more available to patients with legitimate emergencies.
Although the program costs approximately $1 million annually, the fire department received grant funding through the Centers for Medicare & Medicaid Services’ 1115 waiver grant program.
Success All Around
Patients have overwhelmingly given positive feedback about the initiative. “I was concerned that some patients wouldn’t be comfortable with the technology, but they seamlessly transition from talking to a paramedic to a physician,” Dr. Gonzalez said. Of almost 500 encounters, only two patients didn’t want to talk to a physician but didn’t state a reason.
Eighty percent of the time, Project ETHAN has been successful in reducing the need for unnecessary transport via ambulance. “This results in real savings passed on to the patient and the patient’s insurer,” Dr. Gonzalez said.
While the fire department is still crunching the numbers, having reduced the patient encounter from 40 minutes (if taken to the hospital) to only 10 minutes (if transport is not needed) will certainly garner significant savings given the results of a study of Houston emergency departments in 2011.1 The study showed that 40 percent of visits were for primary care–related issues. If those patients went to a clinic instead, more than $2 million could be saved annually.
“Project ETHAN is a real example of what can happen when public and private entities partner to solve complex programs,” said Dr. Gonzalez, who noted that there were some logistical problems in launching the program but now everything is running smoothly.
Reference
- Begley C, Courtney P, Abbass I, et al. Houston hospitals emergency department use study. University of Texas Health Science Center School of Public Health Web site. Accessed May 6, 2015.
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