CareHouston: A Successful Collaboration between a local health department and the local EMS to Reduce Frequent Callers to 9-1-1 American Public Health Association (APHA) 138th Annual Meeting Denver, CO Presented by Algia Hickenbotham, MEd, RN-BC LaTorya Williams, MS Lillie Peter, RN Chrystal Murphy, RN Houston Department of Health and Human Services (HDHHS)

CareHouston A Project of the Houston Fire Department (HFD) EMS Division & Houston Department of Health and Human Services (HDHHS)

Learning Objectives Discuss strategies taken by a local health department and local fire department to address frequent 9-1-1 callers with non-emergent needs. Identify possible interventions used with frequent 9-1-1 callers to better meet their needs and reduce the number of calls to EMS. Discuss cost savings shared by the creation of the CareHouston collaboration between HDHHS and HFD.

What is CareHouston? CareHouston: A program that identifies and tracks frequent 9-1-1 callers. Once identified by the HFD- EMS, they are referred to the HDHHS for follow up.

Who Gets Referred to CareHouston? Residents who called 9-1-1 more than 8-10 times in a 90 day period (which translates to a call about every 10 days). Frequent callers who are residents with chronic health conditions or social needs that require some level of assistance, but not of an urgent nature.

Process: First Step… HDHHS receives a referral list of frequent callers from the HFD every 60-90 days. Staff from HDHHS contacts the resident and attempts to identify underlying problems, such as lack of education about their health condition, transportation, or social issues. HDHHS staff will address the needs, attempt to redirect the resident’s call for EMS/911 services.

Process: Next Step… Service Plan This information is used to develop a plan to educate residents about: Their health and or medical condition Available community resources Services that HFD-EMS can and cannot provide Services that HDHHS can provide Appropriate referrals to agencies that can assist them

Type of Recurrent Needs Most Often Identified Transportation Needs Transportation to/from ER or doctor’s appointments Social Needs Assistance with food, utility and housing repairs Referrals for Medical Assistance Assistance with medication, referrals to home health providers, mental health issues, benefits counseling

CareHouston Team RN Case Manager Counselor HFD-EMS

Jan-Sept 2010 Month EMS Referral Number of contacts Active Cases Closed Cases January 46 7 13 February 55 130 40 19 March 67 29 12 April 28 27 4 May 44 90 63 June 10 132 61 July 20 72 48 24 August 76 Sept. 25 14

Impact of Problem Affects EMS unit availability to service residents with emergent needs. Affects EMS response time to residents with urgent and emergent medical needs. Can lead to moral issues within the workforce and complacency. Cost! It cost the HFD $1,700 every time an EMS unit is sent out to transport a resident.

Results During the Spring of 2008, the total number of residents identified as frequent callers was 98, and 1,117 calls were made to the EMS. After callers were referred to the CareHouston program, calls were reduced to 313. (804 calls diverted). This call reduction allowed the Fire department to redirect $4,576,400 in resources to other areas. .

during evaluation period Results 72% reduction in frequent calls to 9-1-1 during evaluation period

Future Plans Continue to monitor reduction in 911 calls from frequent callers Seek community partners & resources to address identified needs Implement client satisfaction surveys Continue to educate frequent callers when to use 911/EMS services Seek additional funding for more staff and expansion of the program

Satisfied Customers

Thank You!!! For More Information You May Contact: Algia Hickenbotham at algia.hickenbotham@houstontx.gov or Chrystal Murphy at chrystal.murphy@houstontx.gov