Use of care guides to reduce visits by high ED utilizers
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Amanda Schoolmeester, MSN, RN, AGCNS-BC, CEN; Maggie Symons, MSN, RN, CMSRN; Nathan Baar, MHA, BSN, RN, CEN
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Poster presentation
Session A presented Monday, September 30, 10:00-11:00 am
Purpose:High frequency utilizers (HFUs), patients who present ten or more times to the emergency department (ED) in a rolling 12-month period, contribute to ED overcrowding, misuse of resources, and reduce the efficiency of health care systems. The intent for the implementation of care guides to provide consistent direction for patient care was to reduce visits by high frequency utilizers and improve their care continuity.
Design: The was a retrospective description study to understand how the use of care guides reduced number of visits by high frequency utilizers. Incidentally the use of care guides also reduced the number of unique high frequency utilizers of the emergency department.
Setting: The study setting was at a teaching hospital in an urban environment with a level II trauma center designation and approximately 64,000 visits annually.
Participants/Subjects: Patient inclusion was defined by 10 or more visits in a rolling 12 month period. The 10th visit during this time period triggered an alert in the electronic medical record to the assigned Attending Physician prompting them to initiate a care guide. Prior to ED discharge, case management and/or social work followed up with the patient to identify barriers impeding their ability to receive appropriate outpatient care.
Methods: This project started in 2012 with the goal of reducing ED high frequency utilizer visits. The program was designed by the ED Quality and Safety Nurse Specialist in collaboration with the ED Director and ED physician team. The program utilized the 24/7 Social Work coverage and daily 18 hour case management coverage to follow-up on those identified as high frequency utilizers. Prior to starting the program, case management and social work staff along with the ED physicians were trained on the process and inclusion criteria. Staff on-boarded after program inception were trained during orientation without a formal lecture.
Results/Outcomes: From 2013 to 2017 the number of high frequency utilizer patients went from 338 to 104. The number of ED visits by these unique individuals from 2013 to 2017 went from 6,025 to 1,352 annually. This meant that the average number of visits per high frequency utilizer also reduced from 17.8 to 12.9. This confirms that implementation of care guides, and supporting patients to the best place for care reduces use of the emergency department.
Implications: The ED is an immediate way for patients to receive care, however, continuity of care with consistent providers can improve outcomes and quality of care. Based on our findings, it has been identified that connecting patients with appropriate services, practical resources and knowledge results in significantly fewer ED visits. Anecdotally, many patients have appreciated the assistance from our team including the empowerment to care for themselves better. Non-compliance with medical recommendations will continue to present as a challenge with this patient population, but it is possible to impact individuals who are ready and willing to change by removing barriers to care.
Type | Poster |
Format | Text-based Document |
Evidence Level | N/A |
Research Approach | N/A |
Keywords | Emergency; High Frequency Utilizer; Care Guide |
Name | Emergency Nursing 2019 |
Host | Emergency Nurses Association |
Location | Austin, Texas, USA |
Date | 2019 |
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