Non-Emergent use of emergency department - PowerPoint Presentation

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Non-Emergent use of emergency department - PPT Presentation

Principal Investigator Tina Bacorn RN Overcrowding in Emergency Departments Admission to ED numbers have been increasing Implementation of the Affordable Care Act has increased the numbers considerably ID: 273939

care patients medical emergency patients care emergency medical cost emergent department services pain pcp alternative reported analysis information patient fast 2014 http

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Slide1

Non-Emergent use of emergency department

Principal Investigator:

Tina Bacorn, RNSlide2

Overcrowding in Emergency DepartmentsAdmission to ED numbers have been increasing. Implementation of the Affordable Care Act has increased the numbers considerably.

Many of these admissions are not true emergencies

Emergency department costs are the most expensive way to receive primary medical careSlide3

Overcrowding in Emergency DepartmentsCauses:

Sluggish processes for patient throughput

Delayed care for patients with life threatening medical conditions

Delayed relief of pain for patients who present with acute injuries or illnesses

Contributes to the ever rising cost of healthcare in AmericaSlide4

Research Study PurposeTo determine the population using the emergency department for non-emergent purposes

To determine the reason for their choice in using the ED for non-emergent purposes

To correct any identified obstacles to alternative primary care

To re-direct patients to more appropriate facilities, the next time they have a similar complaint, by giving them alternative resource information

To educate patients on their medical complaint

ULTIMATELY: Determine ways to reduce the non-emergent population of the EDSlide5

MethodologyConvenience sample of 100 patients was obtainedMonday-Thursday

Within hours of 0900-1500

Genesis East Emergency Department-Fast Track

During months of October and November 2014Slide6

MethodologyInclusion criteria:Must be triaged at level 4 or 5, based on standard ESI

Practitioner to assess the patient and determine the condition to be non-emergent, could be treated else where, non-emergently, with equal care

Exclusion criteria:

Non-english

speaking patients, pregnant patients, and prisoners.Slide7

MethodologyResearch candidates were presented with informed consent explaining the studyUpon verbal consent, a series of questions were asked of the patient including:

age, gender, primary medical complaint, whether or not they had a PCP, insurance status, and reason for choosing the ED for their medical treatment

Based on their answers, patients were given case specific resource handouts, treated by the practitioner, and then dischargedSlide8

AnalysisOf the 100 patients interviewed:52 were female, 48 were male

Median age was 24.5

All 100 patients were residents of Iowa

Answers were divided up into several categories

Medical Insurance status

PCP status

Type of medical complaint

Alternative resources givenSlide9
Slide10
Slide11

Analysis100 % of the patients could have been seen at an Urgent Care facility

86% of the patients could have been seen at PCP within next 3-7 days, with equal care, and with no additional harm

77% reported having a PCP. However, only 6% reported having actually called their PCP to see if they could be seen. The other 71% stated they just assumed they would not be able to get in.

-The difference between sick slots and routine check ups was explained.Slide12

Analysis30% of the patients were given ORA Orthopedics’ walk-in clinic information: Open Monday-Thursday 1700-2000

92% of the patients given ORA reference did not report severe pain or distress and could have waited an additional couple of hours to go here insteadSlide13

Analysis23% of patients reported not having a PCP

Given Genesis “No Doc” phone number: (563-421-DOCS)

Given contact information and hours of operation on the four community health care sites in the QCA

18% of the patients reported not having medical insurance

Given information on how to sign up for the affordable care act, criteria requirements for Medicaid eligibility, contact information on Genesis Financial Counselor Representative, Rachel

Pai

for assistance in signing up

Informed that Community Health Care also has assistance in signing up for the affordable care act insurance

Slide14

Analysis12% of the patients were seen for chronic pain medication refillsAll of these patients had already established PCP care for their condition, but reported not being able to get into see the PCP before they either “ran out of meds” or the meds “weren’t strong enough”

iven Genesis policy on chronic pain management in the emergency department

Genesis’ policy is to not treat chronic pain with narcotics due to the national epidemic of narcotic substance abuseSlide15

Analysis3% of the patients were seen for dental painGiven 10 separate references for dental clinics, including the Community Health Care clinic that accepts walk-ins every morning, Mon-Fri, starting at 0715am

Chronic pain policy also explained to those patients who reported the dental pain lasting longer than 6 monthsSlide16

“FAST TRACK” – not so much“Fast Track” is a common area of emergency departments, set aside for minor injuries and illnesses

Fast Track is often overcrowded itself resulting in wait times of over 2 hours (ideal door-door is 30 minutes)

Sometimes it can take 30 min-hour just to get these patients triaged

“Convenience” was the number one reason reported for why the patients chose the ED for their medical needs

May 2015: West campus ED saw approx. 3,200 patients and East campus ED saw approx. 3,000 patientsSlide17

Systematic Reviews of LiteratureThe most tested intervention to reduce the non-emergent use of ED’s was case management

Included a multi-disciplinary team of nurses, social workers, and physicians

Locus of intervention not limited to the hospital and often extended into the community

Strong evidence supporting a full time case manager for “Fast Track”. Case management was essentially what this research project turned into.

“

In 2 before-and-after studies, the reduction in hospital costs was larger than the cost of the case management team.” (

Althaus

et al., 2011, p. 47) Slide18

Fiscal ResponsibilityHigh Risk Population

68% had government funded insurance

18% were self-pay

4% had commercial insuranceSlide19

Fiscal Responsibility

Services and Supplies

Eligible Populations by Family Income

<100% FPL 101-150% FPL >150% FPL

Institutional Care

(inpatient hospital care, rehab care, etc.)

50% of cost for 1st day of care

50% of cost for 1st day of care or 10% of cost

50% of cost for 1st day of care or 20% of cost

Non-Institutional Care

(physician visits, physical therapy, etc.)

$3.90

10% of costs

20% of costs

Non-emergency use of the ER

$3.90

$7.80

No limit

Drugs

Preferred drugs

Non-preferred drugs

$3.90

20% of costSlide20

Fiscal Responsibility

Government

insurance pays out based on a set fee schedule. “The Iowa Medicaid Enterprise (IME) fee schedule is a list of the payment amounts, by provider type, associated with the health care procedures and services covered by the IME. Providers are contractually obligated to submit their usual and customary charges but accept the IME fee schedule reimbursement as payment in full.” (Iowa Department of Human Services, 2014

)Slide21

Fiscal ResponsibilityAlternative interventions are now being implemented in ED’s across America due to the financial loss associated with these unpaid bills:

ADVANCED TRIAGESlide22

Advanced TriageNurse and practitioner in the triage roomPractitioner determines whether or not the patient has a life threatening condition or if the potential is there for a life threatening condition to develop

Patients deemed non-emergent are then given resource hand-outs for appropriate alternative facilities, and then discharged w/o treatment.

Estimated door-door time on these patients is less than 10 minutes.Slide23

Advanced Triage

There are three criteria that should be met in order for this process to occur:

1)“The

hospital has determined, after an appropriate medical screening, that the individual does not need emergency medical services.”

2)“An

alternative non-emergency services provider is actually available and accessible in a timely manner to provide the services needed by the individual.”

3)“The

hospital has provided the individual with…the name and location of an alternative non-emergency services provider (as described above);

and

a referral to coordinate scheduling of the individual's treatment by this provider

.”

(

Medicaid.Gov

Keeping America Healthy,

n.d.

)Slide24

Research Study ExtensionsAdditional research forExact amounts of money lost due to unpaid bills of non-emergent population

Fast track case management trial, with follow up phone calls, to identify and address any hurdles the referred patients may have encountered