Unscheduled Care and the New “Emergency”

It won’t come as a surprise to any of the readers of this blog that the use of emergency services of all kinds, from ambulances to emergency departments, is increasing. And most of you probably also already know that one of the reasons for this increase is that more and more patients are using emergency services for non-emergency medical needs. This is particularly true of those who don’t have insurance or a primary care provider.

As Mark Rector, Kristen Miller, and Matt Zavadsky put it in their Navigator talk, what used to be called emergency care is now perhaps more aptly titled unscheduled care. In other words, patients are using emergency services whenever they have unscheduled medical needs. Perhaps their primary care provider is closed because it’s after hours. Perhaps they simply don’t have transportation or any other way to get to a hospital or clinic. Whatever the reason, “emergency” services are now becoming the access point for all kinds of unscheduled care—and are being overloaded as a result.

Rector and his colleagues suggested one interesting alternative: what they call “patient navigation.” Patient navigation, at least for dispatchers and communications centers, refers to the ability to send patients to the most appropriate care provider, not always to the emergency room via ambulance. If patient navigation begins as early as the dispatch point, 911 (or 999, etc.) can become a kind of clearinghouse, evaluating patients and sending the most appropriate transportation to take them to the most appropriate point of care.

And in fact, with emergency room wait times and emergency room costs being what they are, patients themselves are better served, in many cases, by being sent to an urgent care clinic or provided with home care options. The speakers told the story of one patient who insisted that an ambulance take him to the emergency room—then admitted, when he was called back for follow-up the next day, that he would have been much better off taking the suggested alternative care option. He’d spent more than 20 hours at the ED, and he’d been given no more care than if he’d waited and gone to his own doctor the next morning.

An NHS ad educating users away from the ED.

An NHS ad educating users away from the ED.

As you can see from this ad, the National Health Service is going directly to citizens, asking them to redirect themselves to the proper facility. However, given that most citizens are not medically trained, it may be difficult for them to know what counts as a “real emergency.” That, to me, is the value of offering a variety of transportation options and access to a variety of care providers at the dispatch point. It also underscores the necessity for further research to help identify the most appropriate care pathways for various types of patients and various conditions, as well as further research to help emergency dispatchers (and potentially emergency communication nurses) more and more accurately triage patients over the phone.

How about you? What is your agency doing to handle the growing number of calls to 911—especially low-acuity or non-emergency calls? NHS may be paying its dispatchers not to send ambulances, but that doesn’t seem like an option in the American system. What options do you see working in your community?

This entry was posted in 911/999 dispatch, Changes in Emergency Care, Pathways of Care. Bookmark the permalink.

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