Going Beyond the 9-1-1 Call
BC Emergency Health Services (BCEHS)
In 2015, BC Emergency Health Services (BCEHS) received approximately 10,000 Omega calls across its three Dispatch Operations Centres (DOCs) in Kamloops, Vancouver and Victoria. These calls are a subset of low-acuity (non-urgent) 9-1-1 calls that are typically better supported through alternative care pathways, such as HealthLink BC’s Nursing Services, rather than having an ambulance dispatched. When 9-1-1 callers are transferred to Nursing Services, they get in-the-moment clinical advice from a registered nurse, saving them a time-consuming trip to the emergency department.
Despite procedures in place to transfer Omega callers to Nursing Services, 71% of the calls in 2015 were inappropriately assigned an ambulance. This was putting unnecessary strain on ambulance services, for which demand is projected to grow 6% by 2020. With this in mind, BCEHS’s Quality, Patient Safety and Accreditation (QPSA) team worked with HealthLink BC’s Nursing Services and the dispatch centres on a quality improvement initiative aimed at increasing the volume of calls being transferred to alternative care pathways.
The team found that dispatch staff were reluctant to transfer Omega calls because they believed that most calls would end up being transferred back to the dispatch centre. With this insight and data gathered from over 2,000 call audits, the team addressed this misconception through a staff education campaign that included infographics, articles in BCEHS’ Weekly Bulletin, and in-person presentations.
Throughout the project, point-of-care staff and leaders have been consistently engaged in the project through working groups, involvement in a Culture Pulse Survey, and assisting in the design and implementation of additional interventions. Information such as call data analysis was shared with staff from a perspective they would understand and find meaningful – when the QPSA team highlighted how the project would ultimately benefit patients, they saw an almost immediate improvement. Providing tangible, measurable results helped foster accountability and responsibility among staff.
As of June 2017, there was a 173% increase in calls referred to HealthLink BC’s Nursing Services compared to when the project began, meaning that a total of 183 patients per month now access more appropriate support and services and, at the same time, resources are freed up for emergency services to address high-acuity patients’ needs. Overall, the number of Omega calls assigned an ambulance went down by nearly half – from 71% to 36%.
Next steps for the project include expanding the options for external services, with a focus on support for low-acuity mental health patients through Crisis Line or local social service agencies. A staff engagement, communication and transition plan is now in the works to provide support and leadership training on an ongoing basis. Ongoing call audits, feedback education sessions, collaboration with Nursing Services, and celebration of successes across BCEHS will ensure that new processes are truly adopted and sustained in each of the dispatch centres. The project will also be published in an upcoming issue of Healthcare Quarterly, a national publication committed to improving care.