One year on the job in Atlanta, RightSite Health solving age-old problem…

How to care for patients who call 911 for health care when their need is not a critical emergency.

911 calls across the country for health needs that are not critical emergencies strain an overburdened, understaffed emergency health care system. It also isn’t helping the patient.

The 2020 National EMS Assessment shows that more than 18,200 local agencies respond to nearly 28.5 million 911 dispatches yearly. *

“Patients simply don’t know who to call to help solve a health need or problem—and 911 is their answer, which it shouldn’t be,” said Atlanta Fire & Rescue Brian Garner, EMS Chief and a 30-year veteran paramedic who’s worked in several roles in critical care including a flight paramedic.

Since the 1960s*, the protocol for paramedics and emergency personnel to provide and care for their patients often meant taking them by ambulance to the nearest hospital emergency room.

Today, a patient with health care needs that are not life-threatening who is taken by ambulance to a hospital emergency room could wait hours before patient admission. Once admitted, the patient could wait hours for care.

According to a study in the New England Journal of Medicine in September 2021, even before the Covid-19 pandemic, more than 90% of U.S. emergency departments found themselves stressed beyond the breaking point at least some of the time.⁴ Many remain overwhelmed daily.

“Ambulances are making runs to care for people who could be better served by primary care physicians or urgent care centers. They really don’t need a hospital emergency room,” said Garner. “Add in a national paramedic shortage, and it was paramount that we find solutions to manage the non-critical health calls to have the staff and ambulances to care for those who have life-threatening emergencies.”

In 2021, Garner engaged RightSite Health as one of those solutions.

“I tell my paramedics that they should know in the first two minutes of patient assessment whether RightSite should be engaged,” said Garner.

RightSite Health provides an emergency room physician through telehealth at the time of need when paramedics are assessing the patient. Those paramedics who initiate a RightSite call have 90% of their patients in Atlanta choosing not to go to an emergency room.

“What we have learned is that patients calling 911 with non-critical health conditions need connection, guidance and encouragement in using primary care and specialty physicians, pharmacists, and social services. They need help navigating the health care system,” said RightSite Health Founder and CEO Jamo Rubin, M.D.

Once RightSite’s ER physician assesses the patient, a patient advocate called a patient navigator guides them to get the care they need. They make doctor’s appointments, schedule urgent care visits, fill prescriptions, and coordinate round-trip transportation for medical care. In addition, patient navigators also engage local social service agencies that support the health and well-being of their communities when necessary.

“Through a patient lens, we want to solve the problem and release the burden on EMS and hospital emergency rooms,” said Rubin.

Solving problems is part of Rubin’s repertoire. A board-certified anesthesiologist, he was a founding board member for The National Alliance to Impact Social Determinants of Health and founder of TAVHealth, which was acquired by Signify Health in 2019. *TAVHealth built networks of community, health care providers and payers using a single shared cloud-based platform to collaborate and coordinate services to solve social determinants of health and generate better outcomes, lower costs, and a better experience for everyone.

His inspiration for RightSite Health came from his experience—wearing a 30-year-old pair of glasses–and a natural curiosity. “EMS plays a significant role in caring for those struggling with social determinants. And all the threads led to finding a way to get an ER doc alongside those paramedics at the scene.”

In Atlanta, RightSite is working. Those paramedics who initiate a RightSite call are back in service in 20 minutes compared to 2–3 hours offloading at an emergency room. And there has been no repeat 911 calls from those patients treated through RightSite.

“Everyone’s definition of an emergency is different. We can’t tell patients who are in need that they are not having an emergency based on our definition—but we can redirect them to the right site for care,” said Rubin.

 

Sources:

1. *National Association of State EMS Officials releases stats on local agencies, 911 calls

2. *National Emergency Medical Services Education Standards

3. NASDOH

4. *Signify Health buys social determinants technology company TAV Health