Strategies for Reducing ER

Visits and Hospital

ReadmissionsCSI-RI Best Practice Sharing

ConferenceMarch 18, 2011

Katie McGillicuddy, Quality AssistantHillside Avenue Family & Community

Medicine

Quality Assistant receives all hospital forms then

scans and electronically links them to patient’s chart

Linked documents are automatically sent to the doc

through the EHR and require the doc’s electronic

signature

Less paper on doc’s desk!

Hospital admission notices go to NCM for f/u

ER admissions to QA for f/u

Notification/Documentation

ER, Observation and Admissions

NCM initial outreach by phone upon discharge

Determines need for office visit follow-up with NCM or MD

Goes over the Four Pillars and patient access to HFCM

Conducts Med Reconciliation as needed and

refers complex issues or med list changes to MD

NCM uses note template with reportable fields for

all interactions which is sent to the doc via the

EMR for electronic co-signature

NCM Outreach

Admissions

Contacts all patients admitted to the ER

Reminds patients about practice hours and same day

visits

Asks about barriers preventing an office visit

Schedules f/u as needed

Documents information in reportable fields using a note

template

Performs interventions with frequent ER visitors

Letters

NCM call/visit

Gives NCM cell phone number

Quality Assistant Outreach

Emergency Room

Quarterly reports capture the following information:

Name of hospital

Visit time

Date and day of the week

Payor

Reason for admission

Patient readmissions

If patient was referred by HFCM or seen for SDA

Confirmation that pt understands medical condition

Knowledge of HFCM hours/SDA policy

Reporting

Emergency Room

NCM hospital follow-up template

ReportingNCM note template with reportable

fields

ER follow-up clinical elements table

ReportingEmergency Room

Reporting

Sample E.R. report

Quarter 4 (10/1/10-12/31/10) Sunday Monday Tuesday Wednesday Thursday Friday Saturday Grand Total % of Total12:01AM-8:30AM 4 5 5 7 5 4 8 38 14.8%12:01PM-3PM 2 3 4 5 6 6 9 35 13.6%3:01PM-5PM 6 4 4 9 3 3 14 43 16.7%5:01PM-7PM 3 5 7 6 5 4 4 34 13.2%7:01PM-12:00AM 9 10 13 5 13 7 10 67 26.1%8:31AM-12PM 8 2 10 6 3 7 4 40 15.6%

Grand Total 32 29 43 38 35 31 49 257

ER statistics by time and day of week

Quarter 4 (10/1/10-12/31/10) Sunday Monday Tuesday Wednesday Thursday Friday Saturday Grand Total % of Total12:01AM-8:30AM 4 5 5 7 5 4 8 38 14.8%12:01PM-3PM 2 3 4 5 6 6 9 35 13.6%3:01PM-5PM 6 4 4 9 3 3 14 43 16.7%5:01PM-7PM 3 5 7 6 5 4 4 34 13.2%7:01PM-12:00AM 9 10 13 5 13 7 10 67 26.1%

Abdominal Pain 1 1 1 3 15.6%Allergic Reaction 1 1 Back Pain 2 2Chest Pain 1 1 2Depressive Disorder 1 1Fever 1 1Fracture 1 1Gastroenteritis 1 1 2Genito-Urinary Problem 1 1 2Head Injury 1 2 3Headache 1 1Hypertension 2 1 3Kidney Stones 1 1Laceration (w stitches) 1 1Migraine 1 1MVA 2 2Myalgia 1 1 1 1 4Other 2 2 1 5Otitis Media 1 1Pneumonia 1 1 2Rash 1 1 1 3Sprain 1 1 1 1 4Superficial Injury 1 1 1 2 1 6Unknown 2 2 2 1 1 8URI 1 1 2UTI 1 1 2Vomiting 1 1 1 3

8:31AM-12PM 8 2 10 6 3 7 4 40Grand Total 32 29 43 38 35 31 49 257

Reporting: Results

ER statistics detail: reason for visit by time of day

Using Data To Drive Improvement

Emergency Room

Finding: Largest % of ED visits occur 7P – 12A. Discussion / Plan

Emphasize more strongly availability of on-call doctor after 7P

Publicize more widely the answering service number

Investigate the possibility of working with a local Urgent Care center to decrease evening ER visits