Greenville Health System - EMS Nurse Triage and Medical Neighborhoods

Overview

In 2012, the Blue Cross BlueShield of South Carolina Foundation awarded Greenville Health System (GHS) and Greenville County EMS (GCEMS) a $300,000 grant to implement an adult triage call center to reduce unnecessary EMS transports and emergency department (ED) usage. The funds were used to implement a two-phase project to reduce both unnecessary patient use of EMS transport to area EDs and unnecessary patient use of EDs, while providing quality medical care to frequent EMS/ED patients living in designated underserved areas. Analysis of previous EMS transport to area EDs indicated that 65 percent of the 911 ambulance calls were for non-emergency care, yet EMS is required by law to transport patients unless a waiver is signed declining transport.

Phase one of the project implemented EMS Nurse Triage, which provides alternate access to care at the point of 911-dispatch before an ambulance is ever sent. Phase two established GHS’ first Patient-Centered Medical Neighborhoods (PCMNs), which expand beyond just a medical home. For the majority of these patients, EMS and the ED are their source of primary care. Developing patient care within the communities these patients reside in will address their need for easy access to health care, transportation issues and social barriers. Creating PCMNs will require more than just commitment by GHS and GCEMS to caring for these patients. A true medical neighborhood will involve multiple community partners including schools, fire departments, community providers, hospital systems, EMS and other private transportation, churches and public transportation services.

Impact

From June 2013 to August 2016, 4,900 calls were transferred from 911 Dispatch to the EMS Nurse Program. Of those calls, the EMS Nurse Program was able to reduce ED visits by 20 percent and EMS transports by 55 percent. Calls transferred by Dispatch to the registered nurse during this time resulted in 988 avoided ED visits and 2,671 avoided EMS responses. The PCMN pilot went live in February 2016, and the paramedic/social worker team has conducted 823 home visits.

Lessons Learned

Providing alternate access to care at the point of 911-dispatch can significantly reduce avoidable EMS and ED utilization.

Future Goals

GHS is currently collecting data on the PCMN pilot and has hired two additional paramedics and five community health workers in 2016. In addition, they are working with Laurens and Oconee Counties to expand EMS Nurse Triage to support their communities.

Contact: Jennifer Snow
Director, Accountable Communities
Telephone: 864-797-7854
Email: jsnow@ghs.org