Hoping to ease overcrowded emergency rooms and trim ambulance runs, Louisville Metro EMS is launching a program to screen low-priority 911 calls and divert some patients from hospitals to more appropriate care.

Starting Monday, dispatchers will turn a small number of the lowest priority calls — such as an earache or stomachache — over to a nurse, who can spend more time on the phone to decide the most appropriate treatment, which may not include a trip to an emergency room in an ambulance. The nurse may, for example, connect the caller with a doctor’s office or an urgent-care center. “We’re trying to challenge the way things are traditionally done,” said Dr. Neal Richmond, EMS director. “Let’s find these people better care.”

The system, the second of its kind in the nation, is widely used in the United Kingdom and Australia, said Dr. Jeff Clawson, medical director for the National Academies of Emergency Dispatch. While a handful of cities have explored similar programs, only Louisville and Richmond, Va., which piloted the program, are fully implementing it, he said. If used carefully, Clawson said, the system could be a powerful way to “preserve precious resources” while still getting patients needed care. “The time is here for this.”

Clawson said no patient would be denied ambulance service. All would have the choice of consulting with the nurse and, if they still want an ambulance, one would be dispatched. To read full article, please download the documents below.

911 program could ease emergency room problems – USATODAY.com

Download PDF from Louisville.Gov

Download PDF – Original Article in Courier Journal

ems1.com – Ky. 911 program to ease crowded ER rooms

Odyssey clinical decision support systems enable a vast synthesis of clinical knowledge relevant to the patient’s needs to be available to the user instantaneously – at the simple click of a mouse.

An early report on teletriage from Dallas EMS indicated a reduction in nonemergent transports of 20-30%. Now teletriage systems are being introduced in Seattle, Richmond, and Houston. A report by the Controller of the City of Philadelphia projects savings of $2.5 million annually for city EMS services through the deployment of nurse teletriage systems. view more..

Nonemergent medical 911 calls are routed to a teletriage call center to prioritize dispatches for much increased efficiencies. Resources are redirected to true emergencies decreasing response times and significantly increasing the quality of patient care. This may significantly reduce hospital ED over-crowding and over-utilization. This may also substantially reduce the asssociated costs to engine company and law enforcement responders.

Odyssey may be custom configured to automatically track whether an encounter is "immediate", "urgent" or "no special urgency". Since the LifeBot® is the first and only EMS/ED teletriage telemedicine communications workstation that manages both teletriage and ALS calls, transitions may be elegantly managed from one powerful system, even with voice and video recording capabilities.

• Tele-Nursing: Lifting the Burden on Emergency Medical Services Controller of the City of Philadelphia – April 2009 : Estimates that the city may save $2.5 million annually implementing teletriage systems. view..

• Call Screening in Dallas: Triage with Care Journal of Emergency Medicine (JEMS), February 1983 "Dr. Clawson calls the nurse screening approach the "Cadillac" of selective dispatch philosophies. We asked Leilani Starks, RN, coordinator of the Dallas Fire Department’s call screening program, to describe the system there and the special challenges it presents." view..

• Telephone Triage: The Quiet Revolution in Canada O’Hanley, Telemedicine Journal and e-Health – March 2004 : "The computer revolution has for almost a decade been central to a nursing revolution known as telephone triage. The registered nurse can be virtually out in any community to help patients and their caregivers make informed decisions on appropriate emergent intervention and the venue commensurate with the determined level of necessity." This Canadian system handles 100,000 calls a month with 300 nurses. It has handled over 7 million calls for over 10 years without any significant patient legal issues. view..

• ED Telephone Triage: Gridlock or Access Sheila Wheeler : "Timely and appropriate access to care in the emergency department (ED) setting is a problem which has reached crisis proportions. Overcrowding (too many clients) and overutilization (innapropriate and unnecessary ED visits) impede access to healthcare services, sometimes barring those who genuinely need emergency care." view..

• The Case for Publicly Funded Medical Call Centers Schmidt, Hertz, : "60% – 80% of pediatric ED visits are nonurgent or unnecessary (an office visit the next day or self care would be safe and effective). The unnecessary visit rate is lower for adults." view..

• The Future of Telepractice Bio-medicine, Sheila Wheeler, October 2006 : "…in the future, many will practice from large national call centers. In these "mega call centers", nurses may serve as the coordinator from the “hub” of an integrated computer and phone system — a network of phone-based health care services, calls ranging from crisis level to information-based and from telemedicine and internet based service to “POTs” — "plain old telephone" lines.
" view..

• NASEMSO Input to NHTSA Strategic Plan – Docket No. NHTSA-2009-0171 January 4, 2010, Docket from National Association of State EMS Officials, mentioning LifeBot® EMS Workstation by name, that addresses major issues in safety for EMS and first responders. Obviously, if EMS emergency responses may be lowered significantly, as indicated by the teletriage documents above, then this safety for providers may be substantially increased. Costs would not only be reduced for EMS, but law enforcement responders as well. view..

• Tele-Nursing – A Revolution? Ian St. George and Michelle Branney, Healthline, "The coincidence of sophisticated software and critical mass of skilled nurses sets the scene for innovation… Telenursing should become a career path for nurses…" view..

Telemedicine may save millions more…

• Telemedicine and Remote Monitoring Could Save $197 billion Kaufman Foundation – January 2010 : Report by Kauffman Foundation and Brookings Institute economist Robert E. Litan. "Remote monitoring can spot health problems sooner, reduce hospitalization, improve life quality and save money," The United States economy could save $197 billion over 25 years by implementing policies that support remote monitoring and other telemedicine technologies. A failure to encourage healthcare providers to take advantage of telemedicine would cut the projected savings by almost $44 billion view..

• Survey: Consumers psyched about telemedical remote monitoring "A new survey by PricewaterhouseCoopers concluded that almost three-fourths of U.S. consumers say that they’d use telemedical services, which they defined as remote monitoring to track their condition and vital signs…. Researchers concluded that half of consumers would be willing to get healthcare online or through other computer technology instead of face-to-face care for non-emergency visits." view..

• Broadband Internet’s Value for Rural America. USDA – Economic Research Report – August 2009 "The cost of not having telemedicine thus was estimated to average $370,000 per annum for the 24 rural hospitals. Communities with larger hospitals (2,000 or more patient encounters per month) would be forgoing over $500,000 per year if telemedicine were not offered." Obviously for groups of hospitals or large provider organizations this means millions in savings regionally. view..

• Predicted utilization of emergency medical services telemedicine in decreasing ambulance transports. Prehospital Emergency Care, Haskins, Mayrose – 12/2002 "Use of EMS telemedicine could result in an approximately 15% decrease in ambulance transports when it alone is added to the prehospital care provider’s armamentarium. Emphasis for implementation should be placed on younger patients and an identified subset of chief complaints conducive to management using telemedicine." view..

• National Telemedicine Initiatives: Essential to Healthcare Reform Telemedicine and eHealth, American Telemedicine Association – July 2009 "…telemedicine offers significant opportunities to address the issues of inequities in access to care, cost containment, and quality enhancement." This paper by top telemedicine authorities illustrates where substantially more savings may be realized beyond the above references. view..

Emergency Preparedness and Disaster Relief…

• JAC Report to Congress and the 9/11 Commission 12/2002 Kevin Martin, FCC Chairman – February 4, 2008 “In order to receive the benefits of telemedicine, electronic health care records,and other healthcare benefits, health providers must have access to underlying broadband infrastructure.” This report and recommendations from some of the nation’s most prominent officials also recommends IP based communications. The LifeBot® EMS Workstation is the only such IP based VOIP workstation available. view..