Volusia County announces end of vaunted Nurse Triage 911 effort; will cut most staff

Several nurses employed by Volusia County government recently learned that they will lose their jobs at the end of March.

The reason? The county is cutting its Nurse Triage program as of March 31 because it isn't producing the results officials hoped for, even though the county has at times touted the program as a resource saver. County officials said their hopes for the program didn't materialize. But some familiar with the decision question the move.

The point of the program is to save critical resources for true emergencies.

Volusia County Emergency Medical Services launched the program in 2019. Nurses employed by the program are based with 911 operators and are trained to handle 911 calls.

Here's how it works: A 911 dispatcher gets a call. If the dispatcher determines that the issue isn't an emergency requiring a traditional respone, he or she will transfer the call to the Nurse Triage unit. A nurse asks the caller questions and determines what care to arrange: it could be for the caller to handle matters at home, or perhaps a trip to urgent care or the doctor. The nurses can send an ambulance or an EMS van to transport patients.

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Five part-time nurses and one full-time nurse make up the unit.

Volusia County Emergency Services Director Jim Judge said the county found the program wasn't worth keeping financially because many of the callers were still taken by ambulance to an emergency room. The county had trouble finding alternative care sites to accept patients, Judge said.

"We gave it our best shot to try to have the program become successful," he said.

Michael Vincent, clinical services manager for Volusia County EMS, estimated that over half of the calls that came into the Nurse Triage program got an ambulance-only response or greater.

Early challenges

At the beginning of the Nurse Triage program county officials tried to build relationships with urgent care centers, federally qualified health clinics and other non-emergency room facilities to be able to send patients there, Vincent said.

But the county ran into challenges early on, Vincent said.

"Really what happened was is a lot of the federally qualified health clinics require patients to be already registered there or they had a six-week waiting list for new patients," he said. "A lot of our urgent cares, you know, if we have somebody that's maybe on a fixed income, something like that, they can be seen in an ER without paying a copay to be seen. The urgent care models are a little different. They require copay kind of up front."

Ultimately the program wasn't able to get patients to the alternative sites as much as they had intended, he said.

Judge added, "And so, you know, as a result of that, ultimately the patients ended up going to the emergency room, and many times going by ambulance to the ER."

Judge said the nurses "did everything they could possibly do to make the program work."

Concerns about losing the program

The county is offering the full-time nurses another position in Emergency Medical Services, but the part-time nurses will have to leave, Judge said.

The county won't have a need for part-time nurses or a budget to keep them once the program ends, according to a county spokesman. But the nurses will leave in good standing.

The county plans to divert funds that would have gone toward the program "into other areas" to keep residents safe, Judge said.

He said the county is looking into the possibility of a community paramedicine program that could conduct home visits to check in on people who frequently call for emergency medical services.

People familiar with the decision to cut the Nurse Triage program, who spoke on condition of anonymity because of concerns about hurting their careers, said they are concerned that the change will end up hurting residents. They expressed concern that people with true emergencies might have to wait longer as more resources are devoted to non-emergencies.

Cut came as a surprise

Those familiar with the decision also said the program cut came as a surprise to people on the team.

The program received an achievement award from the National Association of Counties in 2021. A News-Journal story about the award noted that from December 2019 to March 25, 2021, the program handled 2,167 calls and helped close to 400 patients avoid an Emergency Medical Services response.

The program, over the same time frame, also freed up advanced life support ambulances 176 times by providing a basic life-support ambulance instead.

Judge said he doesn't believe cutting the program will have a negative impact on patient services. He said the county's response times look good and the county has a lot of resources for responding to patient emergencies. Judge said the county also plans to up its efforts to educate people about how to properly use 911.

Employees with DUIs to help

Nurses who work in the triage program also help with coordinating inter-facility patient transfers, which is an addition to their regular duties.

People familiar with the decision to cut the Nurse Triage program said that employees who have gotten DUIs will help with administrative duties related to that work as part of being reassigned in the division. They would not help with clinical care.

Judge said Emergency Medical Services "did have a couple of DUIs" and those people will be placed in administrative positions, and they will be asked to help with administrative tasks related to inter-facility transfers, among other duties.

"Rather than just throw these people out, we try to find a location and a place where they can continue to be successful," Judge said.

But Judge said that isn't connected to the county's decision to cut the part-time nurses instead of attempting to find a job for them elsewhere.

"That had nothing to do with nurse triage one way or the other," he said.

This article originally appeared on The Daytona Beach News-Journal: Volusia's Nurse Triage program to end; most nurses will lose jobs