Patient Education: Proper use of Emergency Department
Leadership Learning Experience
A.1. The problem I identified revolves around educating patients on the proper use of benefits and services, mainly the use of the Emergency room as primary care. I work as a nurse Care Manager and find it quite difficult to get patients to stay out of the Emergency room for non-emergent needs. As a Care Manager I believe it would be beneficial to address the educational needs of the patients as it relates to disease management and the proper use of benefits and services. Thereby; decreasing the use of the Emergency room as primary care.
a. Patients who don’t have a primary care doctor will most often use the Emergency room as primary care. According to the New England Healthcare Institute (March, 2010) “The overuse of U.S. emergency departments (EDs) is responsible for $38 billion
in wasteful spending each year.” The overuse of the Emergency department can cause a ripple effect in the type of care the patient receives. As a Care Manager my goal is to make sure there is continuity of care for the patient. If the patient continues to utilize the ER, it makes it difficult to ensure continuity, in that it’s difficult to keep up with all of the prescribing doctors. New England Healthcare Institute (March, 2010)
2.a. My investigation included the use of articles available via Ebscohost as well as the getting the view of my resource person within my department. The source in my department stated that” early intervention with patient follow and being able to answer questions patients may have concerning newly prescribed medications after a visit to the ED, helps to decrease the chance of the patient going back to the ED to seek care”. One article in particular titled, Office- Based patient education decreases non-emergent emergency department visits (2011) stated that “patient education appears to have resulted in a statistically significant meaningful decrease in Emergency room visits”. Their research showed that timely follow up with the patient, educating the patient on disease/symptom management and educating the staff on how to triage the calls, showed a 6.2% decrease in ED visits from the pre-intervention of 6.83%. Adesara, R., Spencer, J. P., & Bost, J. E. (2011)
3. As stated above the use of the ED resulted $38 billion in wasteful spending in the U.S each year; NEHI (March, 2010). According to NEHI (March, 2010) Some of the root causes for the overuse of of the ED revolved around patients not having access to timely primary care, the ED being convenient because of the after hours and weekend care, and often times the primary provider will refer the patient to the ER. The annual number of emergency department visits in the United States increased nearly 20%, from the 96.5 million to 115.3 million over a 10 year period ending in 2005. NEHI (March, 2010)
a. Contributing to problem includes lack of patient education on the proper use of benefits and services as well as access to care. Patients are likely to use the ED when they can’t access their primary care provider. According to NEHI (March, 2010) patients feel as if the ED is easily accessible as compared to regular clinics or primary care settings. The ED is open 24/7 365 days a year, whereas; primary care clinics are limited to the availability in the hours and or days to which they are open. Also it has been stated previously that primary care provider will often refer their patients to the ED for issues that may be deemed as non-emergent. NEHI (March, 2010)
4. Implementing Case Managers can help to decrease the number of patient who repeatedly use the ED. This is done by Case Management collaborating with the different providers to assess and create a care plan for the patient. This study found that the average number of yearly patient emergency department visits decreased from 26.5% to 6.5% following the implementation of Case Management.NEHI (March, 2010). Also providing patients with educational materials and empowering them through education to manage their own conditions, where appropriate, showed a reduction in ED usage. Patients who are able to access care and receive information related to their condition, offers the patient reassurance which may ED visits. New England Healthcare Institute (March, 2010)
a. As stated above implementing Case Management and educating the patients can reduce the percentage of patients who seek care in the ED from 26.5% to 6.5% on the average yearly basis.NEHI (March, 2010)
5. Resources include disease specific management information sheets, and letters informing patients on how to properly access to assist in education. Also providing patients with access to things like telehealth, same day appointments, telephone access to after and urgent care facilities may also help to reduce the number of patients who seek care from the ED. Also can offer patients Healthy incentives, the patient would earn points for each time they visited their PCP and completed follow-up appointments. These points can lead to $10 gas cards, gift cards or a waving of the office co-payment. NEHI (March, 2010)
a. According to the Journal of healthcare management (2013) “healthcare cost decreased by an average 0f $1,042” per person per ER visit for patients had some type of intervention i.e patient education or were exposed to case management”. While that number may seem minimal compared to the overall yearly cost of $38 billion as stated earlier, it is a step in the positive direction. Enard, K. R., & Ganelin, D. M. (2013)
6. The first step in helping to implement my proposal would be to utilize the admission system in my organization to alert me when patients of a particular PCP comes to the ER. Once a pattern has been established, I would then contact that PCP and see how as a care manager I can assist with the care of the patients who utilizes the ED as a primary care option. After receiving the green light from the PCP, I would then begin outreach to those patients who have identified to engage them in care management services. Once the patient is engaged, the Case manager, PCP and patient will come up with a plan of care to assist the patient with management of their condition, thereby; decreasing their need to use the ER. The total process should completed with 90 days.
7. Primary key stakeholders would include the patient/patient’s family, physician, case manager and any other specialist the patient may be receiving care from. Other stakeholders may include ED department and hospitals. By decreasing the use of the ED for non-emergent needs a decrease in the ED wait times, patient to staff ratio in the ED, and overcrowding may be prevented. New England Healthcare Institute (March, 2010)
a. The patient and the care providers are instrumental in the process, in that compliance from all parties involved will provide for better care for the patient and allows for continuity, Thereby; decreasing the need to seek care in the ED. The care manager’s role would consist of educating the patient and making sure all of the pieces of the puzzle fit.
b. Summarize your engagement with the key stakeholders and/or appropriate partners, including the input and feedback you received.
c. Working with the key stakeholders would initially involve a meeting to discuss the plan of care for the patient. After the initial contact weekly to bi-weekly contact will be made via telephone to address any questions or concerns the patient may have and to update the PCP and/or specialist on the patient’s care team. I would also explain to them the importance of continuity of care and how important it is to prevent a lapse in care.
8. The first step in helping to decrease the use of the ED as a source of primary care would be to identify those patients who are considered high risk or repeat offenders. Once those patients are identified working with the primary care provider and patient; as a team we would create a plan of care which includes access to care and education on disease/symptom management. Those patients considered high risk will be followed by Case management from 30-90 days to continually reinforce the importance of following the plan of care and receiving their care from their primary care providers. New England Healthcare Institute (March, 2010)
Discuss how your proposed solution or innovation could be implemented.
a. The implementation will be evaluated by a decline in the notifications received from the admission system alerting the case manager to patients going to the ED and by keeping a log of patients who are being case managed to see if there is a decrease in their usage or an increase in their PCP visits.
B. 1. As the scientist I had to research articles and journals to review data and statistics pertaining to my topic of choice.
2. As a detective I had to identify the key stakeholders, identify the problem and come up with a solution to the proposed problem. I also had to identify a resource person within my organization who would be willing to help me implement my proposal.
3. As the manager of the healing environment I would implement the practices learned throughout my research on a daily basis with the patients who have been identified as those needing care management. By working closely with the patients I have a chance of effectively changing the patient’s views on how to access care and by overall changing their views as it relates to their healthcare needs.
C. Submit the completed attached “Professional Verification Form” from the organizational leader advising you in your leadership experience.
Enard, K. R., & Ganelin, D. M. (2013). Reducing Preventable Emergency Department Utilization and Costs by Using Community Health Workers as Patient Navigators. Journal Of Healthcare Management, 58(6), 412-427.
New England Healthcare Institute (March, 2010) A matter of urgency;Reducing Emergency Department overuse; Retrieved from: http://www.nehi.net/writable/publication_files/file/nehi_ed_overuse_issue_brief_032610finaledits.pdf
Suffoletto, B., Hu, J., Guyette, M., & Callaway, C. (2014). Factors contributing to emergency department care within 30 days of hospital discharge and potential ways to prevent it: differences in perspectives of patients, caregivers, and emergency physicians. Journal Of Hospital Medicine, 9(5), 315-319. doi:10.1002/jhm.2167
Adesara, R., Spencer, J. P., & Bost, J. E. (2011). Office-based patient education decreases non-emergent emergency department visits. The Journal Of Medical Practice Management: MPM, 27(3), 131-135.
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