Navigating care: Honolulu considers rideshare initiative aimed at reducing strain on Oahu’s emergency services

HONOLULU (HawaiiNewsNow) - As 911 calls for medical help soar, HNN Investigates a proposal that would help take some of the strain off Oahu’s emergency rooms and ambulance crews.

The Nurse Navigator program would enlist the help of rideshare drivers to shuttle patients who aren’t having an emergency to an urgent care or doctor’s office.

It’s a program that’s currently being used in 15 states in more than 30 jurisdictions across the continent.

Locally, officials at Honolulu Emergency Medical Services estimate it could help redirect as many as 9,000 911 calls a year. This would free up Oahu’s limited EMS crews — as well as ER beds — making them available for emergencies.

For paramedics with Honolulu EMS, there’s no such thing as a slow day.

“Their call volume is just going up and up,” said Honolulu Emergency Services Director Jim Ireland.

This year, Oahu’s 22 ambulances are on track to transport 60,000 patients. Officials say a big chunk of those calls are not urgent and require neither an ambulance nor an emergency room.

Ireland said, “Up to like 40 percent of our callers are for non-emergency situations.”

Here are a few recent examples of what he’s talking about: “I have a runny nose. I feel constipated. I can’t sleep. My acrylic nail came off. I have gout pain.”

It’s why Honolulu EMS is working to establish a partnership with a third-party company called Nurse Navigator. The program would be tied in with the county’s 911 system. If a dispatcher determines the call is minor in nature, it would be transferred.

“The Nurse Navigator would then send a rideshare for the patient to get to an urgent care or a doctor’s office,” Ireland said.

HNN Investigates

Depending on the circumstance, the agency also has the ability to provide advice for self care, or connect a patient with a health care provider virtually through a telehealth visit.

Ireland said, “The fourth option would be use a basic life support ambulance to take the patient probably to an emergency room, but it wouldn’t be a paramedic ambulance from the city.”

It’s a plan that has the backing of Oahu’s hospitals.

“If there are other settings in which patients can receive the type of care they need we’re very supportive of that,” said Healthcare Association of Hawaii CEO Hilton Raethel.

Raethel says in total, there are only 177 emergency room beds on Oahu, an island with nearly 1 million people.

Raethel said, “We want to ensure our hospitals can take care of the people who really need care in an emergency room.”

Ireland added, “The Nurse Navigator program even offers pharmacy ride-sharing. So if the patient needs to get to the urgent care and then get to the pharmacy, that’s covered.”

HNN Investigates took the idea to the streets to find out what the public thought about it.

“My understanding is there is a lot of waste of ambulance rides for folks that don’t have proper insurance, and giving them an alternative seems like a great way to save resources for people who really need them,” said Kiel Anderson.

Shanelle Sakamoto said she’d never heard anything like it, calling it, “pretty cool.”

Melissa Danielson added, “I thought that was a great idea.”

Sakamoto also recognized there could be potential issues.

“There are some people who don’t feel comfortable taking Ubers, because, you know, who are these people?” she said.

HNN Investigates confirmed the Nurse Navigator will obtain a caller’s consent prior to arranging a pickup.

“Ultimately the patient has a choice whether or not they want to use rideshare,” said Dr. Gerad Troutman, national medical director for Global Medical Response.

Troutman says people with mobility issues, a potentially contagious disease, or anyone who is a potential danger to themselves or others will not qualify for a rideshare transport.

When asked how the company establishes which drivers take Nurse Navigator calls, he responded, “They would just roll into the normal pool of rideshare availability that’s out there in the community.”

Troutman added, “It’s not different than if you took an Uber rideshare out to dinner.”

“The other thing that’s very significant is when you take the cost of an ambulance, which is over $2,000 and the cost of an ER visit, which can be anywhere between $1,000 and $5,000. And we look at 10% of our call volume that’s (a savings) in excess of $25 million a year in health care costs,” said Ireland.

As for the cost to the patient: “The ride to the pharmacy and the ride to the urgent care is all covered by the Nurse Navigator program,” Ireland said, “so the city would pay the fee to Nurse Navigation.”

Patients would be responsible for any copays and prescription costs.

One of the ways the city’s looking at funding the program is through taxes already being collected to enhance 911 services.

Ireland says if they can get the money part worked out by the end of the year, the program could go into effect as early as this spring.

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