Christina Duncan’s phone dinged, an alert that meant a new patient was in the queue.
Duncan, a nurse practitioner, sprang into action, bringing up the patient’s case on a tablet with details noted by another Dispatch employee at the centralized call center in Denver. Mike Conrad, an emergency medical technician, also looked over the patient’s details as Duncan gave her a call.
Duncan and Conrad work for Dispatch, a company formally known as DispatchHealth that provides mobile medical care out of a vehicle, which is essentially an urgent care on wheels.
The Dispatch office in Spokane Valley is more like a garage and large supply closet than a traditional office, but that fits the model of a company seeking to bring the house call back to health care.
Teams are out in the community in people’s homes for the majority of their shifts.
Once the team confirmed the patient was home and wanted them to come, they packed up their bags. Duncan put her laptop and a travel-sized printer into her backpack; Conrad ensured that all of the medical supplies potentially necessary were packed into large plastic boxes shaped like suitcases.
The rest of the supplies were in the back of the vehicle, which is bright blue with “MultiCare” emblazoned on the side, and a tablet is mounted to the dashboard to direct them to the house.
Dispatch partnered with MultiCare in Tacoma last year but expanded to the Spokane area in August. Patients requesting care from Dispatch can use their phone, app or computer. They then talk to a Dispatch employee in Denver to determine whether Dispatch is the appropriate service for their needs. If so, the local team is notified, and they call the patient directly.
For Dispatch in Spokane, most referrals come from MultiCare-affiliated providers, but anyone can use the service. Costs for a visit vary depending on a person’s insurer, but generally a person with insurance can expect to pay up to $50. Generally, patients with state Medicaid plans don’t pay for Dispatch services, while a person with commercial insurance can expect a charge between $20 and $50.
When patients initially talk to the Dispatch employee, cost estimates are shared with them upfront. Patients are billed about a week after they receive care. In the Spokane region, Dispatch cannot take Tricare insurance plans, as well as some Kaiser Permanente plans. People without health insurance can use Dispatch and pay a flat $275 fee.
There are six Dispatch teams in Spokane and two vehicles they use, and they have seen more than 240 patients since Aug. 14.
The Dispatch service is available every day from 8 a.m. to 10 p.m., and is not intended for medical emergencies, but more for urgent-care-like medical needs.
Duncan and Conrad have treated lots of different calls, from replacing catheters to strep throat or flu calls.
They have a 45-minute window to get to the patient’s house. At the start of their late shift (noon to 10 p.m.) on Oct. 11, Duncan and Conrad responded to a call from the South Hill.
Norma Samis had called Dispatch after initially calling her health care provider. MultiCare suggested that she go to the emergency room for an irritating skin infection, called cellulitis, or call Dispatch. She opted to call Dispatch instead.
Duncan, with her backpack, and Conrad, with his two big boxes, walked up to the house, and Samis called them in. The living room where Samis sat soon turned into a do-it-yourself doctor’s office.
Conrad spread out a cloth and prepared a few instruments on a side table, while Duncan, sitting on the couch, opened her laptop and started to document Samis’ medical record. Samis was prepared, with her insurance cards and identification, as well as a full list of medications she was taking.
Due to medications she was taking, Duncan decided they should do a blood test. The team drew blood from Samis’ arm, and she never had to leave the chair where she sat. Dispatch teams carry a $10,000 machine that looks like a credit card reader that can test a patient’s blood in about two minutes. The initial test came back with a result Duncan seriously doubted, and she decided to prick Samis’ finger instead for a blood test. With a better reading this time, Duncan began her exam of the irritation.
She confirmed it was cellulitis, and because it looked infected, Duncan prescribed an antibiotic. She gave Samis her first dose right then, and ordered the prescription to the pharmacy from her laptop. Samis said her nephew could pick up the prescription. Duncan also suggested warm compresses, in order to ease the inflammation.
In less than an hour, Duncan had printed out all of Samis’ final paperwork, which she had already transmitted to her primary care provider. Samis had an appointment with her doctor for the following week, which Duncan encouraged her to keep. Conrad packed up the boxes and threw the used needles in the designated portable hazardous waste bin attached to one of the boxes.
Conrad made sure Samis had water and was not hungry before he finished up his packing.
“I would have gone to the emergency room if I hadn’t got this,” Samis said.
MultiCare partnered with Dispatch in several Northwest cities to provide another option in patient care for those just like Samis, who might otherwise be waiting in long urgent care or emergency room lines for ailments that need urgent attention, but can also be treated at home.
Christi McCarren, senior vice president for retail health and community-based care at MultiCare, said the partnership began as a way to treat patients, particularly those over the age of 60, who might have mobility challenges or would usually have to wait in emergency rooms for care.
“We were trying to find a way for us to provide great care for them at home that was more appropriate than them coming into the ER,” McCarren said. “For them to go into the ER and get admitted, that’s not always a good situation for them.”
The partnership enables health care providers in the MultiCare and Rockwood system as well as Dispatch providers to treat patients in a continuum of care.
Dispatch providers have read-only access to MultiCare patient medical records, expediting intake and evaluation for Dispatch teams on-site. Dispatch will likely expand their services and add a third vehicle to the team in Spokane as early as next year.
Brian Schaeffer, fire chief of the Spokane Fire Department, sees Dispatch’s services and model as complimentary to city emergency medical services. City EMS responds to life-threatening medical emergencies, which is not a part of Dispatch’s services, although Dispatch has an opportunity to cut back unnecessary ER visits through its model.
“Reducing the utilization of 9-1-1 is in line with what we do, and reducing the amount of ED (emergency department) visits is exactly in line with what we do,” Schaeffer said.
Dispatch serves the Spokane County area, but providers have gone as far as Stevens County to provide care. The exact service area is outlined via ZIP code on the Dispatch website.
On a typical day, a team will see about seven patients. The average time spent with a patient is about 45 minutes to an hour, a big change of pace for former EMTs or ER nurses, like Conrad or Duncan.
Conrad worked as an EMT in a fire department, and working for Dispatch has been a big change of pace for him. Duncan worked most recently in an urgent care clinic, where she saw about 30 patients a day, she said. The team raved about their relatively new jobs, largely due to the more personal interaction with patients.
“It’s fun, and it doesn’t feel like they’re at the doctor’s office or a clinic, because we are in your living room,” Conrad said. “We’ve seen a lot of success and a lot of patient satisfaction, when we go out together, we’ve been invited back for dinner.”
For providers and patients alike, Dispatch represents either a brand-new way to do health care or a return to how it used to be.
“I see this as the future of health care,” Duncan said.
Editor’s note: This article was changed on Oct. 22, 2019 to include DispatchHealth, the formal name of Dispatch.
Arielle Dreher's reporting for The Spokesman-Review is funded in part by Report for America and by members of the Spokane community. This story can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.
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