Righting the non-emergent 911/EMS call

One year on the job in Atlanta, RightSite Health is helping a 911/EMS system that is overwhelmed with calls find better options for non-emergent patients.

Fifty percent of the calls received by 911/EMS are from patients who have very real but non-emergent needs. The mission of EMS is to respond to every call – fast. With so many non-emergent trips, EMS sometimes finds itself without enough available ambulances to respond to true emergencies on time.

“Ambulances are making runs to care for people better served by primary care physicians or urgent care centers. They don’t need a hospital emergency room, which is the only place EMS can take patients,” said Brian Garner, Section Chief of EMS Field Operations at Atlanta Fire Rescue, and a 30-year veteran paramedic. “The non-emergent patients are taking up major bandwidth and we had to find solutions, so staff and ambulances could care for those with life-threatening emergencies.”

In 2021, Atlanta Fire Rescue engaged RightSite Health as one of those solutions.

Through telehealth, RightSite Health’s ER Telehealth Doctors work with EMS to care for the patients. We are seeing that, when offered the option by on-scene EMS, many non-emergent patients choose a telehealth visit with an ER Doctor in their home instead of a long and uncomfortable journey through the ER. Those same EMS crews can be back in service in 14 minutes versus the 2-3 hours offloading they might experience at the ER loading dock.

“It’s saving us precious time and resources,” said Garner.

Helping patients find the right health care

“Over half of the patients calling 911/EMS need 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.

RightSite Health’s solution for helping these patients is providing on-scene EMS crews with on-demand ER physician telehealth, accompanied by a Patient Navigator.

Following the direction of RightSite Health’s ER Telehealth Doctors and EMS, RightSite Patient Navigators, who are trained in empathic conversation, talk with patients to understand their needs. They stay in constant touch with patients to 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 patients with things like financial assistance, housing, and counseling.

“Through a patient-centered lens, we want to solve their non-clinical needs and barriers to obtaining care, while easing the burden on EMS and hospital emergency rooms,” said Rubin.

Overcrowded emergency rooms

Because of healthcare laws and reimbursement rules, the only destination for EMS and their patients is a trip to the nearest hospital emergency room, where non-emergent patients can wait hours for care.

“Hospital emergency room crowding has been an issue for decades. ERs have become the primary healthcare provider for many people as the healthcare system has grown near impossible to access and navigate,” said Rubin. “It’s driving up health care costs and creating staff burnout that leads to major clinical staff shortages in the EMS and hospital setting.”

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

Social Determinants of Health (SDOH)

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’s mission was to address social determinants of health by building networks of community-based organizations. The network allowed social services, providers, and health plans to collaborate services on TAVHealth’s referral platform. By focusing on a person’s non-clinical needs and barriers, this collaboration generated better outcomes, lower costs, and a better experience for everyone.

“Social and non-clinical determinants play a big role in the health of our communities.  If you don’t have a car and don’t live close to public transportation, you don’t go to your doctor appointments, which impacts your health,” said Rubin. “And when you get to the end of your rope and need help, you call 911.”

Armed with a natural curiosity, Rubin’s experience led him down the path to find solutions to big issues plaguing U.S. health care: an overwhelmed 911/EMS system, ER crowding, wasted health plan dollars, and SDOH. It’s his inspiration for founding RightSite Health.  “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 Telehealth Doctor alongside those EMS crews at the scene and getting a Patient Navigator in the mix to help the patient get what they need, instead of going to the hospital ER. With RightSite Health, everyone wins.”