Changes at Atlanta’s sole911 ambulance service mean paramedics may now send callers with less-urgent ailments to neighborhood clinics instead of the emergency room.
Grady Emergency Medical Services leaders hope the program, thoughtby state officials and Grady to be the first of its kind in Georgia, will free emergency department staffers to focus on their most critically ill patients and give callers with less-urgent problems better service, said Dr. Arthur Yancey, the medical director of Grady EMS. It could also speed ambulance response.
“This is the vanguard,” Yancey said. “I do believe medical care is going this direction in the U.S.”
Each day, between 15 and 20 of the city's 911 callers have sore throats, toothaches or other problems that one of the health system's eight neighborhood clinics could easily handle, Yancey said. Grady EMS receives about 100,000 calls each year.
They call for an ambulance because they lack transportation, health insurance or primary care physicians, Yancey and experts said. Most have low incomes.
They know of no better place to get care but the emergency room at Grady, Atlanta’s charity hospital.
During the new system's first phase, dispatchers identify which callers have one in a list of 20 less-urgent complaints, such as a ring stuck on a finger.
Paramedics confirm the caller’s condition at the scene. Patients who are adults, in stable condition, are in a normal mental state, can walk and sit on their own, and have straightforward medical histories have the option of being driven to a neighborhood clinic.
No patient is required to go there.
Costs to patients will drop drastically, Yancey said. Grady clinics charge between $20 and $75 per visit, depending on patient income. The emergency room charges non-urgent patients at least $220 to be evaluated and treated by a doctor.
Grady has not estimated how much money it might save through the program or how it may affect wait times for the emergency room because it depends on how often patients opt for clinic care, Yancey said.
Later this year, dispatchers will transfer less-urgent calls to nurses, who will screen patients by phone. They will give advice, set up clinic appointments and arrange for rides for people who need them.
Currently, one Grady clinic -- the DeKalb Grady Health Center -- is receiving less-urgent patients.
The Rev. Tim McDonald, a patient advocate, likes the new concept in theory. It might inform residents about the neighborhood clinics, which are underused, he said.
McDonald, a leader of the Grady Coalition, a hospital watchdog group, worries that if a patient dies after being sent to a clinic by mistake, others who opted against emergency room care might deluge Grady with lawsuits.
“I don’t know if it will work or not," McDonald said. "I have my reservations.”
Lawsuits and care quality are real concerns, said Dr. John Ma, chairman of the department of emergency medicine for the Oregon Health & Science University in Portland, Ore., and a board member for the Society for Academic Emergency Medicine. Organizers need to take special care training paramedics, dispatchers and nurses, he said.
While Grady's efforts appear worthwhile, they are unlikely to end emergency room overcrowding, Ma said. The aging population, insurance issues and the availability of primary care physicians need to be addressed, as well.
The Richmond Ambulance Authority in Virginia has run a similar system since 2006 and has not seen a jump in lawsuits, Chief Administrative Officer Lee Ann Baker said.
Ambulance Authority nurses connect patients with non-emergency clinics and make follow-up calls. While officials think the program provides an important service, Baker said it is difficult to calculate whether it is saving medical facilities money or easing overcrowding.
The ambulance service breaks even on the program. Much of the potential savings doesn't show up on its balance sheet because separate companies own the hospitals and clinics, Baker said. Grady owns all the medical services involved in its program.
Because of the sluggish economy, the Richmond program struggles to save anyone money. Free clinics and other alternatives have shut down, which means dispatchers have no choice but to send patients with toothaches to the emergency room, Baker said.
"It can be a great program," Baker said, "but make sure you have the resources to support it."
The state Department of Community Health approved Grady’s new system April 19. The changes began May 3.
As of Thursday morning, four patients had opted to go to a clinic instead of the emergency room, a Grady spokeswoman said.
The Grady Coalition has received no complaints, McDonald said.
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