As you know, the United States spends far more on health care than other industrialized nations. That excess spending is a drag on our economy. So I see one of my jobs as a City Commissioner as looking for ways to reduce unnecessary medical spending. And as Commissioner in charge of Portland’s 9-1-1 system, I have a little piece of the health care system, because many 9-1-1 calls are medical calls. And although many callers absolutely need to get an ambulance to the emergency department (ED) right away, research shows that our system generates a fair number of unnecessary emergency room visits.
Some jurisdictions have reduced unnecessary ambulance trips to the ED by having 9-1-1 direct some callers to a “nurse triage” line. Last week, I joined a group from the Portland region on a trip to Reno, Nevada, where a Nurse Health Line offers 24/7 access to assessment, clinical education, triage, and referral to health care and community services. Reno believes that this service ensures that people get the right kind of care at the right time when they call 9-1-1 with a medical concern. The site visit offered some important insights that we can use here in Portland.
Reno’s program, which is managed by REMSA (Regional Emergency Management Services Authority, a nonprofit ambulance service), provides patients with quicker access to medical information and more care choices from a team of specially-trained experienced registered nurses. REMSA’s nurses don’t substitute for primary care, but they help patients access the right level of care, including connecting uninsured patients with available resources.
In Portland, a similar initiative would require collaboration between Multnomah County, which is responsible for providing Emergency Medical Services, and the City, which is responsible for providing 9-1-1 service. It would also require an investment - both financial and non-financial - from the health care community. The group that traveled to Reno included:
- Multnomah and Clackamas Counties
- Clark Regional Emergency Services Agency in Vancouver
- AMR, which provides ambulance service in Multnomah County
- Health Share of Oregon
- FamilyCare Incorporated
- Providence Medical Group
My personal observations after reflecting on what I learned in Reno include:
- We cannot overstate the need for excellent community outreach. Reno decided to offer a non-emergency phone number for anyone to call with any medical issue or question. At the same time, they triage some lower acuity calls from 9-1-1 to the Nurse Health Line. Regardless of the approach, we would need to allocate time and resources to develop the new program for the community.
- All partners must engage early to design a program that will work here in Portland. REMSA engaged a broad array of partners in the areas of health care, community, quality improvement, and technology. The group that traveled to Reno from Portland is a great start for the range of stakeholders who would need to be involved for an initiative here.
- Dedicated funding is critical – but if we have the right stakeholders involved, the value will far outweigh the cost. REMSA received a $9.8 million Health Care Innovation grant from the federal government for their Nurse Health Line. Their grant funds expire later this year, and they are planning to sustain the innovation by working with partners and insurers who have realized savings because the Nurse Health Line has kept people out of ambulances and emergency rooms. Without a federal grant to help us get started, Portland would need to have the partners together at the start to align the value of this innovation with those who would benefit.
- We must make outcomes a priority. REMSA has carefully established its goals for the Nurse Health Line and collected data to track progress toward those goals. Preliminary results show the line saved over $3 million over fourteen months by avoiding 2,296 emergency department visits and 414 ambulance transports. REMSA has also tracked the safety of the Nurse Health Line and has identified zero adverse outcomes --- and, they ask patients about their experience and receive comments like, “I love the program, you helped me through a hard and scary time.” If we decided to move forward with a similar initiative here in Portland, we would need to identify and track these kinds of outcomes from the outset.