How the District of Columbia Increased Health Literacy and Reduced 911 Non-Emergency Calls with Strategic Digital Communications

The District of Columbia’s Fire and Emergency Medical Services (FEMS) Department was experiencing a record number of calls to their 911 emergency line—many of them for non-emergencies. As the District’s population continued to grow and call volume mounted, non-emergency calls began to overwhelm the system and became a strain on the District’s limited resources for ambulatory and emergency services.

Recognizing the need for a way to redirect non-emergency calls, FEMS worked with other District agencies to create a Nurse Triage Line (NTL), accessible to callers via 911 and FEMS members in the field. Callers with non-life-threatening situations are now transferred by 911 operators to the NTL (or FEMS members who have responded and taken the vitals of the patient) to get the best care for their unique needs. When appropriate, nurses fielding calls direct patients to local clinics for care instead of an emergency department. This ensures they received the Right Care, Right Now (RCRN).

Soon into the program’s launch, Right Care, Right Now realized callers were not immediately satisfied with the Nurse Triage Line. Patients did not yet trust the services from the NTL, so many would hang up and call 911 again — this time sharing more exaggerated symptoms to get a ride to the emergency department. As a result, FEMS was still experiencing the same strain on resourcing and staff.

To create behavior change and help increase the health literacy of District residents, FEMS partnered with the Granicus Experience Group (GXG), a team of digital strategy experts. Acting as an extension of the FEMS team, GXG began to build a foundational communications strategy by gathering stakeholder and audience data via surveys and interviews. Through this early work, the GXG team determined the needs and pain points of patients, as well as call center and clinic staff, to create a holistic view of the patient journey—from a call to 911 to outpatient follow-up. GXG built core persona profiles reflecting the most common audience members, including Medicaid patients, which make up roughly 40% of the District’s 911 calls.

These exercises, informed by the data gathered during interviews and surveys, highlighted several important opportunities, including:

1. Increased education directly to patients via SMS campaigns, teaching patients how to proactively manage their health, how to access care at a clinic, and what to expect during a visit.
2. A re-engagement campaign between the Right Care, Right Now clinics and FEMS to rejuvenate the excitement and potential of the program.
3. Re-engaging those who had called 911, were triaged by the NTL, and had visited a clinic, to continue their health journey with the clinic instead of calling 911.
4. Guiding new patients through an education journey around RCRN and its mission and benefits.

With these insights in mind, GXG designed a strategic text messaging program to communicate directly with patients on health education.

The program featured a series of SMS and email communications campaigns that provided basic education to patients on how to proactively manage their health, messaged ER and RCRN patients about alternatives to 911 when appropriate, and built a series of nurture campaigns that ensure RCRN meets the needs of all new patients.

Given its success at aligning care with patient needs, the NTL has since expanded its capabilities to provide self-care suggestions for minor conditions – reducing unnecessary trips to medical facilities, delivering improved care to patients, and alleviating strained emergency resources in the District.

The foundational, multichannel program helped DC be ready to respond to the COVID-19 crisis and the resulting communications needs. In 2020, the Right Care, Right Now program obtained a list of more than 260,000 phone numbers comprised of Medicaid users across the District. DC FEMS partnered with the DC mayor’s office to disseminate health information vital to public safety and well-being, as quickly as possible to the widest possible audience. This partnership has significantly increased the mayor’s reach, empowering city officials to more effectively respond to and curtail the spread of the coronavirus.”