The AHRQ Innovations Exchange site at www.innovations.ahrq.gov summarizes how San Diego’s Emergency Medical Services (EMS) was able to implement and use their “Resource Access Program” (RAP). The RAP program funded by the Office of the National Coordinator for HIT and the Alliance Healthcare Foundation identifies individuals who frequently call 911 to arrange for relevant medical, social services, and other interventions.
The San Diego EMS serves 1.3 million people living in a 362 square mile area. The city contracts with rural Metro Ambulance Corporation to handle more than 100,000 calls to 911 each year.
There is a need to determine the frequent users calling for EMS. The health and social problems of individuals who frequently call 911 cannot be addressed unless these individuals can be quickly identified as frequent callers. To address this problem, RAP uses a sophisticated IT system that immediately recognizes and notifies a program coordinator whenever a frequent user calls 911.
When a frequent caller is recognized, an experienced paramedic is then able to alert a network of community stakeholders and implement measures to address the caller’s immediate and underlying health and social needs.
When EMTs respond to a 911 call, they immediately input the information provided by patients or people at the scene into a handheld wireless computer. The information includes the chief complaint and relevant health issues.
RAP uses sophisticated software algorithms to prioritize individuals by the frequency of use and the nature of health conditions. Using this information, the system generates a list of the most frequent 911 callers by week, month, or year with the list being continuously updated.
The first step is to enter the information into the computer then the software tool links the information to the regional health information exchange called “San Diego Connect”. The system uses algorithms to identify whether the patient is a frequent caller and highlights key issues such as history of substance abuse, psychiatric problems, and in-home falls that typically account for a large proportion of 911 calls.
If the patient has previously been identified as a frequent user by the RAP coordinator, the software tool automatically pages the person and in some cases other members of the patient’s care team. At this point, the RAP coordinator may choose to meet the patient in the emergency department to help the emergency physician determine an appropriate follow-up plan.
By using the software tool, EMS has significantly reduced transports for frequent 911 callers which has led to major cost savings.
For more information, email James Dunford, MD, EMS Medical Director for San Diego at jdunford@sandiego.gov.