911 Services

Whoever thinks about the people who make repeated, unnecessary 911 services calls that can tie up medical workers when a real emergency exists? In a pilot program, the City of Baltimore is now hooking them up with case workers and has succeeded in drastically cutting the number of such calls while helping callers get proper care – and saving money at a time when fire and emergency medical services (EMS) departments are getting their budgets slashed across the country.

The program, called Operation Care, was conceived and implemented by the non-profit agency Baltimore HealthCare Access and ran as a three-month pilot in 2008. Now, a newly published report of its results can help other cities that may be plagued by the same problem find similar strategies for their EMS departments.

In three months, the program generated savings of more than $14,300, more than $6,300 of which was for the city fire department, freeing up ambulances for other callers. Some making the calls had chronic health conditions, like hypertension and diabetes, but nearly 70 percent of the referrals were to non-medical services.

“The original idea was to help these frequent callers get better access to medical and other care and, in doing so, Baltimore City ended up saving money and resources, a welcome side effect,” says lead author Michael Rinke, M.D., a pediatrician and a quality and safety expert at Johns Hopkins Children’s Center.

The Baltimore City Fire Department, which responds to nearly 150,000 emergency calls each year, has continued to fund the program, providing a nurse and a case manager for repeat 911 callers.

In 2007, one caller was responsible for 147 911 calls, while others made 60 and 110 calls each, requiring EMS to dispatch an ambulance to all calls.

Repeated 911 callers, the researchers reasoned, may face problems such as lack of health insurance and access to routine medical care or an inability to navigate the labyrinth of healthcare services.

Ten callers made 520 calls to 911 in the year preceding their enrollment in Operation Care. Based on their call pattern from the previous year, the researchers estimated that these 10 people would make 100 calls to 911 during the three months of the program. But there were only 57 calls, nearly half as many as they had predicted.

Nine of the 10 patients had insurance, mostly through Medicare. All 10 patients had two or more chronic conditions, including hypertension, diabetes and heart disease. Seven had either a mental health or a substance abuse problem or both. The average age was 60 years, ranging from 39 to 89 years.

The case manager referred patients to insurance assistance programs, medical specialists, adult-care services, food services like Meals on Wheels, psychiatric evaluation and support groups for substance abuse.

Deborah DiSesa Hirsch is an award-winning health and technology writer who has worked for newspapers, magazines and IBM (News - Alert) in her 20-year career. To read more of her articles, please visit her columnist page.