Emergency medical services telephone referral program: an alternative approach to nonurgent 911 calls

To examine the effects of transferring nonurgent 911 calls to a telephone consulting nurse. It was hypothesized that the telephone referral program would result in fewer basic life support (BLS) responses with no adverse patient outcome or decrease in patient satisfaction.

A two-phased prospective study was conducted in an urban and rural setting with a population of 650,000. During phase I, a BLS unit was dispatched on all calls and a nurse intervention was simulated. During phase II, no BLS unit was dispatched for calls meeting study criteria. Callers were transferred to the nurse, and consulting nurse protocols were used to direct care. Data were collected from dispatch, BLS, nurse, and hospital records and patient self-assessment.

During phase I, 38 callers were transferred to the consulting nurse with no nurse intervention. During phase II, 133 cases were transferred to the nurse line. There were no adverse outcomes detected. The nurse recommended home care for 31%, physician referral for 24%, referral back to 911 for 17%, community resource for 11%, and other referral for 17%. Nurses contacted 85 patients for telephone follow-up. Ninety-four percent of the patients reported feeling better, 6% felt the same, and none felt worse. Patients were satisfied with the outcome in 96% of the cases.

Transferring 911 calls to a nurse line resulted in fewer BLS responses and no adverse patient outcomes, while maintaining high patient satisfaction. Dispatch criteria correctly identified cases with minimal medical needs. A high percentage of the patients reported feeling better after the intervention. This study has major implications for communities interested in efficient use of emergency medical services resources.