LAUSR

Study Objective: The COVID19 pandemic saw unprecedented increases in call volume to the New York City (NYC) 911 system. Several large health systems collaborated with the NYC Fire Department to transfer low-acuity 911 caller to hospital-based telemedicine services in to ease the burden on EMS. We describe the results of a single center participating in this program, and the results of a nurse follow-up program for diverted calls. Methods: Emergency dispatchers screened 911 calls using a computerized algorithm. Eligible calls were then transferred to hospital-based hotlines for further triage by a registered nurse (RN) or physician assistant (PA). An ambulance was dispatched for calls deemed not appropriate for telemedicine. Otherwise, medical information was given by the RN/PA or a telehealth visit was initiated. Data on demographics, clinical presentation and call outcomes were entered into a REDCap database during initial call. A RN attempted follow-up calls on all patients within 48 hours of initial during the first three months of the program. Results: Between 4/3/20 and 10/2/20, 459 calls were diverted to the triage line, averaging 6 to 10 calls per day. Calls originated from all five boroughs: Brooklyn (26.2%), Bronx (30.2%), Manhattan (23.5%), Queens (17.3%), and Staten Island (2.7%). The median age was 58 (range 4-85 years), and half were female. Shortness of breath (29%), nausea/vomiting (29%) and myalgias/malaise (23%) were the most common symptoms. Approximately 21.5% of calls were related to COVID-19. Among completed calls, 55% resulted in subsequent ambulance dispatch, most commonly due to medical necessity or patient preference. The proportion of calls resulting ambulance response after transfer increased as pandemic levels decreased largely due to patient preference. Among appropriate transfers, 35% were referred to telemedicine while 39% received medical advice from the triage RN/PA. However, only 15 patients were able to complete a telemedicine call, mostly due to technical issues accessing the telemedicine platform. Among the 320 attempted follow-ups, 144 patients (45%) were contacted. Many patients (60%) called 911 again after triage;none of the 15 patients completing a telemedicine visit sought additional care. Thirty-three patients had been admitted to the hospital since the initial call, with one patient in the ICU. Conclusion: Our institution successfully participated in a NYC-wide pilot to divert selected 911 calls to hospital-based telemedicine resulting in fewer ambulance dispatches and more appropriate allocation of EMS resources during the pandemic. However, many callers sought subsequent care after diversion with some requiring hospitalization, and patient acceptance of diversion decreased as pandemic conditions improved. More specific initial screening algorithms, public education campaigns and streamlined IT workflows could significantly increase the volume and effectiveness of similar 911 diversion programs. [Formula presented]