The AHRQ Health Care Innovations Exchange http://innovations.ahrq.gov has determined that the issue of identify people using emergency services for non-urgent conditions should be a high priority area. Studies have found that the most common use of emergency departments for non-urgent and chronic conditions is often for behavioral health conditions.
The result is that patients often receive fragmented care and inadequate management of underlying medical, behavioral and psychosocial needs, at the same time that emergency services are overburdened and struggling with limited resources.
The City of San Diego has made some progress. Emergency Medical Services (EMS) serves a population of 1.3 million living in a 362 square mile area. The city contracts with rural Metro Ambulance Corporation to handle more than 1000,000 calls to 911 each year.
The city’s EMS system has a data driven system using health IT to help identify frequent callers and connects them to a program coordinator known as the Resources Access Program (RAP) to identify frequent callers using IT by monitoring the EHRs within the EMS system.
RAP uses a software tool called “Street Sense” that uses algorithms linked to the regional HIE to prioritize individuals by frequency of use and health condition. The system is able to generate a list of the most frequent 911 callers by week, month, or year.
After a frequent caller is identified, an ambulance or fire engine with at least one paramedic and one or more emergency medical technicians respond. After arriving, personnel input information provided by the patient at the scene into a handheld wireless computer.
If the patient has been previously identified as a frequent user by the RAP coordinator, Street Sense automatically pages the patient’s care team. The RAP coordinator may meet the patient in the emergency department to assist in determining an appropriate follow-up plan. In addition, the RAP Coordinator can use the IT system to determine meaningful trends to identify emerging needs and determine what community resources would be helpful to use.
It has been found that by using the Street Sense IT system, there continues to be progress in reducing calls from frequent callers. In a pilot study, EMS charges fell by 32 percent and fewer encounters, translated into a 40 percent drop in the number of hours spent by EMS workers caring for frequent callers.
In addition, there was a 47 percent reduction in the number of miles traveled by emergency vehicles. Based on internal program data from 2012 and 2013, program leaders conservatively estimate that RAP generates net savings, of about $700,000 a year.