CareHouston: A successful collaboration between a local health department and the local EMS to reduce frequent callers to 9-1-1

In 2006, the City of Houston experienced a high volume of non emergent 911 calls to certain areas of the city. As a result of this high call volume, a collaborative effort between the Houston Department of Health and Human Services (HDHHS) and the Houston Fire Department (HFD) was initiated as a pilot program.

CareHouston identifies and tracks frequent 9-1-1 callers to Houston's 911 EMS. Frequent callers with non-emergent complaints can lead to issues with availability of EMS apparatus in large, high-call volume cities. Frequent responses to non-emergent callers can affect response time or unit availability. Many frequent callers were residents who had a chronic health condition or a social need that required some level of urgent but not emergent assistance.

The HDHHS team consisted of RN case managers, mid level managers and outreach workers. The HFD team consisted of firefighters, HFD Psychologist and EMS workers. HDHHS' team receives a list from the HFD's dispatch center that provides records to the team each month for the prior 90 days. Patients who had called eight times or more within the report period (which translates to a call about every 10 days) were included. Of the 60,000 total calls this process returns, some are filtered due to the transient nature of the patients or the severity of the incident. Calls from public locations are also omitted. The HDHHS team makes initial contact by sending a letter, followed by phone calls to set an appointment to visit the patient and discuss their situation. If no contact is made, they attempt a “cold call” visit. Once the HDHHS team meets with the patient, a needs assessment is completed.

Some 18 patients were identified as frequent callers. These patients accounted for 113 9-1-1 calls during this period. These patients were referred to HDHHS and contacted by the RN case managers. They accounted for only 33 responses, representing a 70% decrease. Eight of the patients (approximately 40% of the identified patient population) made no 9-1-1 calls. By December 2006, the 70% reduction was maintained. The program is currently being maintained and seeking additional funding for expansion.