To better connect non-emergent 911 callers to appropriate care, Washington, DC, routed low-acuity callers to nurses. Nurses could provide non-emergent transportation to a health centre, recommend self-care or return callers to the traditional 911 system. Over about one year, 6,053 callers were randomized (1:1) to receive a business-as-usual response (n_control = 3,023) or further triage (n_treatment = 3,030). We report on seven of nine outcomes, which were pre-registered (https://osf.io/xderw). The proportion of calls resulting in an ambulance dispatch dropped from 97% to 56% (β = −1.216 (−1.324, −1.108), P < 0.001), and those resulting in an ambulance transport dropped from 73% to 45% (β = −3.376 (−3.615, −3.137), P < 0.001). Among those callers who were Medicaid beneficiaries, within 24 hours, the proportion of calls resulting in an emergency department visit for issues classified as non-emergent or primary care physician (PCP) treatable dropped from 29.5% to 25.1% (β = −0.230 (−0.391, −0.069), P < 0.001), and the proportion resulting in the caller visiting a PCP rose from 2.5% to 8.2% (β = 1.252 (0.889, 1.615), P < 0.001). Over the longer time span of six months, we failed to detect evidence of impacts on emergency department visits, PCP visits or Medicaid expenditures. From a safety perspective, 13 callers randomized to treatment were eventually diagnosed with a time-sensitive illness, all of whom were quickly triaged to an ambulance response. These short-term effects suggest that nurse-led triage of non-emergent calls can safely connect callers to more appropriate, timely care.

为了更好地将非紧急 911 呼叫者与适当的护理联系起来，华盛顿特区将低危呼叫者转接给护士。护士可以提供前往健康中心的非紧急交通服务，推荐自我护理或将呼叫者返回传统的 911 系统。在大约一年的时间里，6,053 名呼叫者被随机分配 （1：1） 接受正常响应（n_对照 = 3,023）或进一步分类（n_治疗 = 3,030）。我们报告了 9 个结局中的 7 个，这些结局是预先注册的 （https://osf.io/xderw）。导致救护车调度的呼叫比例从 97% 下降到 56% （β = -1.216 （-1.324， -1.108），P < 0.001），导致救护车运输的呼叫比例从 73% 下降到 45% （β = -3.376 （-3.615， -3.137），P < 0.001）。在那些作为 Medicaid 受益人的呼叫者中，在 24 小时内，因被归类为非紧急或初级保健医生 （PCP） 可治疗的问题而导致急诊科就诊的电话比例从 29.5% 下降到 25.1%（β = -0.230 （-0.391， -0.069），P < 0.001），导致呼叫者访问 PCP 的比例从 2.5% 上升到 8.2% （β = 1.252 （0.889， 1.615），P < 0.001）。在六个月的较长时间跨度内，我们未能发现对急诊科就诊、PCP 就诊或 Medicaid 支出影响的证据。从安全角度来看，随机接受治疗的 13 名呼叫者最终被诊断出患有时间敏感性疾病，他们都被迅速分流到救护车响应。这些短期影响表明，护士主导的非紧急呼叫分诊可以安全地将呼叫者连接到更合适、更及时的护理。