San Francisco Civic Bridge

September 2018-Feburary 2019

CHALLENGE

Cosine Collective and the San Francisco Department of Emergency Management (DEM) partnered through San Francisco’s Civic Bridge program to explore alternative ways to address non-acute emergency calls for San Francisco’s 911 system. Cosine Collective’s job was to explore ways other cities are dealing with 911 calls that do not need EMT response and/or hospital emergency care and make a recommendation to DEM based on our research.

PROCESS

We first identified the key issues DEM was trying to address with an alternative system. Once we understood that DEM was experiencing an increase in call volume and, therefore, a stress on emergency services, we started to explore how other cities have dealt with the same issues. Our research explored both international and domestic cities, focusing on Fort Worth, TX, Washington DC and Reno, NV. We also conducted extensive interviews with DEM stakeholders including quality insurance, San Francisco Fire, dispatchers and Medical Directors to understand their pain points and where they see opportunities for improvement. In addition, we sat in with 911 call takers and dispatchers to understand their work flow and the challenges they face when trying to determine the caller’s needs.

RESULTS

• Through our conversations with other cities, we developed a VCAP, a User Journey Map and a resource tree for San Francisco. These tools helped us conclude that a nurse triage system that is integrated with the current 911 call center would be effective for San Francisco. We found that the nurse triage system reduces strain on emergency responders, as well as increases patient satisfaction.
• Internal stakeholders were enthusiastic about using the nurse triage system because it is a better way to allocate limited emergency resources for those experiencing life or death emergencies. This approach can potentially be very effective for San Francisco because it has a number of alternative care options such as urgent care centers and primary care providers.
• The success of nurse triage program in other cities depended on their network of medical care options and alternative transportation resources such as Lyft or Uber. Moving forward, San Francisco DEM will need to work extensively with these transportation resources to build a network of alternative care for people with non-acute emergencies who call 911.
• Next steps are for San Francisco DEM to engage city stakeholders to create interest and support for this program. Cosine Collective has started the process of identifying these key stakeholders and developing materials to communicate the proposed nurse triage system with them. We see great opportunities to collaborate with the city in advocating for such a beneficial program.

Cosine Collective Team

Joyce Lu | Karin Senado | Kelsey Byrd | Serena Chan | Stacey Fischer | Vanessa Hernandez