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Washington County to introduce EMS "Nurse Navigator" to triage nonurgent 911 calls
Summary
Health and Human Services staff presented a new EMS Nurse Navigator program planned to launch in late February to reduce nonurgent ambulance transports, improve patient routing and ease pressure on EMS and hospitals; AMR Northwest is covering first-year costs, presenters said.
Washington County commissioners heard a detailed presentation Feb. 25 on a new Emergency Medical Services (EMS) Nurse Navigator program intended to redirect nonurgent 911 callers to more appropriate care, presenters said.
The program, presented by Adrian Donner, program supervisor for Public Health with Washington County Health and Human Services, and Tim Case, program coordinator for the countys public health EMS program, is intended to add a secondary clinical screening step after 911 call-takers identify certain complaint types. That step would give callers alternatives such as self-care guidance, urgent-care or same-day clinic appointments, a telehealth visit, or a rideshare to an appointment when transportation is a barrier.
County officials said the change aims to reduce unnecessary ambulance dispatches and emergency-department visits, freeing EMS crews to respond to life-threatening calls. Donner told the board that local data from February 2024 showed about 45,000 calls that were not immediately life-threatening and could benefit from alternatives to ambulance transport.
Under the proposed workflow, 911 call-takers perform the usual triage. If a call falls into predetermined categories, the caller would be transferred to a Nurse Navigator for a secondary clinical screening. That nurse then determines the appropriate disposition: self-care guidance, scheduled clinic care, referral to a primary care clinician, urgent care, or return referral to 911 dispatch if the caller needs emergency transport.
Presenters described results from four phase-one jurisdictions selected as comparators: about 21% of routed callers were resolved with self care, roughly 61% ultimately proceeded to basic life-support (BLS) ambulance dispatch (timed to match the callers needs rather than as an immediate emergency), and about 4% required advanced life-support (ALS) dispatch. Tim Case said those figures represent initial rollout data and that the mix typically shifts as systems and staff gain experience.
"We want the patient to receive the right care at the right time and, importantly, in the right place," Adrian Donner said. "Nurse navigation helps identify when an urgent clinic or telehealth appointment is more appropriate than an ambulance and an ED visit."
Commissioner Jason Snyder, who identified his background as a paramedic during questioning, pressed presenters on two operational points: who pays for rideshare transports used to bridge patients to appointments, and whether the programs initial data (61% routed back to BLS) reflected an acceptable use of limited BLS capacity. Snyder said the 61% figure "seems pretty wild" given field limitations.
Tim Case and Donner replied that AMR Northwest is funding the program for the first year and that the program operator bases its fee on the number of calls routed to nurse navigation. Donner added that regional fire partners have reserved funds to support part of a second year while the county evaluates utility and cost-effectiveness. Case and Donner said the county and its EMS partners will monitor local percentages and adjust triage pathways and call categories as the program matures.
"The first year of the program is being paid for by AMR Northwest," Donner said. "At probably the midway point we'll be looking at whether it is worth the money and how to fund it long-term."
Presenters also described program features intended to support quality and equity: a Power BI dashboard for near-real-time quality assurance and monitoring; follow-up surveys within 24 hours to confirm clinical needs were met; language-line access and some bilingual nurses to serve callers who do not speak English; and integration rules to ensure text-to-911 calls continue to receive an ambulance when the caller cannot vocalize.
Commissioner Jerry Willey noted longstanding ambulance availability problems and said the program could reduce nonurgent calls that tie up crews for long hospital offloads. Vice Chair Therese thanked staff and urged follow-up reporting.
Board members asked staff to return with local program performance data in subsequent months. Presenters told the board the program is scheduled to begin immediately: in the presentation Donner said it would "launch tomorrow," and later referenced a start date of "next Tuesday," a discrepancy commissioners asked staff to clarify as the rollout proceeds. Officials said testing between the county 911 center (WACA) and the Nurse Navigator vendor was either underway or scheduled for the days immediately before the program launch.
No formal action was taken at the Feb. 25 meeting; commissioners accepted the presentation and asked staff to monitor outcomes and return with periodic reports.
Washington County officials said they would provide updates after the program has operated for a quarter so the board can compare local results with early-phase jurisdictions.
