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Ideas for reducing ER visits and EMS transports
The Houston Fire Department has been at the forefront of addressing a growing challenge within urban emergency services. Excerpts from NPR.com highlight how this department is innovatively tackling the issue of non-emergency calls that often overwhelm their resources. As one firefighter mentioned, "We make numerous trips that aren't truly emergencies, but while en route, we might receive a distress call for something serious—like a shooting or cardiac arrest—and find ourselves stretched thin."
Recently, Houston firefighter Tyler Hooper responded to a call at an apartment complex near Hobby Airport during heavy rainfall. Susan Carrington, 56, was sitting on her couch, visibly unwell. When asked if she'd seen a doctor recently, she admitted she hadn't. Her breathing difficulties had persisted for four days, and despite being treated for pneumonia earlier in January, her condition hadn't improved.
Traditionally, firefighters like Hooper would transport such patients directly to the emergency room as a precautionary measure. However, Houston has introduced a groundbreaking initiative called Project Ethan (Emergency TeleHealth and Navigation). This program allows first responders to connect patients with doctors via video conferencing tools, offering alternatives to traditional ER visits.
In Carrington's case, after reviewing her initial examination results, Hooper connected her with Dr. Kenneth Margolis, who appeared on a tablet screen. After a thorough virtual consultation, Dr. Margolis determined that an ER visit wasn't necessary. Instead, he arranged for her to see a local clinic the following morning and even secured a free cab ride for her.
This approach isn't about dismissing patients; rather, it provides a viable alternative by connecting individuals with appropriate healthcare resources. Dr. Michael Gonzalez, the project director and an emergency medicine professor at Baylor College of Medicine, emphasizes the importance of directing low-priority cases toward primary care facilities. This ensures ambulances remain available in their areas while reducing strain on already overcrowded ERs.
Additionally, city health teams follow up with patients post-intervention to address underlying issues contributing to misuse of emergency services. While funding comes partly from federal Medicaid waivers, the annual cost exceeds $1 million. Yet, Dr. Gonzalez believes the long-term savings for the regional healthcare system will far outweigh these expenses.
A 2011 study revealed that 40% of ER visits in the Houston area stemmed from conditions better suited for primary care settings. Treating these cases in clinics costs significantly less—ranging between $165 to $262 per visit compared to $600 to $1,200 in ERs. Redirecting these cases could save over $2 million annually.
This innovative strategy reflects a forward-thinking solution to balancing efficiency and quality care, proving that sometimes technology and thoughtful planning can transform traditional systems into smarter ones.