Dignity Health-supported program cuts inefficient use of ambulances
Every paramedic and emergency room nurse has a litany of stories like this: A chronically ill person falls at home and an ambulance is dispatched. The patient, complaining of pain, is taken to the emergency room, where medical personnel examine and discharge him or her.
Three days later — maybe sooner — another 911 call comes from the same address for the same thing. The routine is dangerous for the patient, expensive for the ambulance authority and the hospital, and provides no real solution to the patient's fall risk.
A small agency in Las Vegas is trying to find a better way.
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The Second Responders 911 Referral Program began with student volunteers in 2013. It works with four area fire departments, including Las Vegas Fire and Rescue, to identify frequent users of 911 and find more cost-effective ways to meet their needs. Hospitals and psychiatric facilities also refer patients to the program.
Dignity Health – St. Rose Dominican hospitals in Henderson, Nev., a suburb of Las Vegas, has donated more than $160,000 to Second Responders, including $60,000 in 2018 and $60,000 this year. The hospital says the program improves emergency medical services response times for the greatest emergency need and reduces ER wait times and ER visits. Dignity Health is part of Chicago-based CommonSpirit Health.
Alexandria Anderson is executive director of the Southern Nevada Community Health Improvement Program, a nonprofit agency founded to operate Second Responders. She said the funding from Dignity Health – St. Rose Dominican, combined with municipal funding and other support, allowed her to hire a professional staff of five.
"Some people are isolated and believe that calling 911 is their only option," Anderson said. "When we get referrals, we go out and do holistic assessments to get a clear picture of what the needs really are and find appropriate help."
Services can be as simple as paying for transport on the Lyft ride-sharing platform for transportation to clinics or hospitals. Anderson said the savings are considerable. An average ambulance call costs $870. She said her agency has been able to assist clients for an average cost of $305 per year.
"If you have somebody calling 911 ten times, think of the savings," she said.
The Second Responders staff works with local hospitals, universities and social service agencies to create individual care plans, which have reduced the clients' need to call 911 by two-thirds.
The university connections also provide Anderson with student volunteers from their social work and nursing programs. Anderson said the students receive valuable experience and help the paid staff serve more people in need. Professional social workers also donate time.
The Southern Nevada Community Health Improvement Program also sponsors other programs for the benefit of low-income people, including neighborhood health fairs.
Anderson said Sarah McCrea, an assistant Las Vegas fire chief and veteran paramedic, organized Second Responders. Anderson became one of the volunteers two years later, and the overseeing agency hired her as director in 2017. McCrea serves on the agency's board of directors. The 911 follow-on service formally is called the Second Responders Emergency Medical Services Response Program.
McCrea became aware of the extent of the problem of people using 911 for nonemergency calls during her 14 years making runs as a firefighter/paramedic for the Las Vegas department.
"A lot of people who use 911 truly have other unmet medical or social needs," said McCrea. "Some think that a ride on an ambulance means they'll see a doctor right away. Paramedics are trained for specific skills. It is frustrating to see the same people over and over again and not be able to solve their underlying problems."
In 2013, McCrea attended an emergency medical services conference and heard of a program in Spokane, Wash., that worked with a local university to help repeat 911 callers. With endorsement by her department, McCrea contacted the social work departments at local universities to recruit student volunteers. Second Responders was incorporated as a nonprofit in 2015.
"I believe it's working," Anderson said. "We have reduced unnecessary EMS calls and visits to EDs. We are providing better health care to people, and the community benefits from more efficient use of its health spending."
Anderson said she and her staff outlined their efforts with a presentation in 2017 at the EMS World Expo, an annual convention and trade show for paramedics. Anderson said she learned of several other communities have similar programs.
The grant from Dignity Health – St. Rose Dominican to Second Responders is part of the $350,000 that the hospital donated this year to eight area nonprofits to improve community health.