The Harris County Hospital District The Harris County Hospital District

ProgramProgramPete Dancy, FACHEPete Dancy, FACHE

Associate AdministratorAssociate AdministratorBen Taub General HospitalBen Taub General Hospital

Houston, TexasHouston, Texas

April 3, 2008April 3, 2008

Ben Taub General Hospital • Level 1 Trauma Center• Over 89,000 EC Visits FY 06

Lyndon B. Johnson General Hospital• Level 3 Trauma Center• Over 64,000 EC Visits FY 06

Harris County Hospital District (HCHD) Harris County Hospital District (HCHD) Emergency CentersEmergency Centers

EC CompressionEC Compression 4/1/2008 (Ben Taub) EC diversion was implemented @ 20:32 at the

request of ANM and with the approval of medicine staff. They remain open to trauma.

EC is at 144% saturation. All shock rooms are currently full with two patients waiting in the hallway on stretchers. Holding has a total of forty patients most of which are still being evaluated. All admits have beds and are being transferred without delay.

Launched August 2006 Major Objectives

Shift Primary Care Related Visits to Most Appropriate Settings

Provide the Right Level of Care at the Right Place at the Right Time

Reduce EC Overcrowding Provide Better EC Access for True Emergencies Teach Patients About Good Use of EC Resources Find Patients a Medical Home for Primary Care

RightCareRightCare

Patient Presents to EC Triaged by an EC Nurse Using a 5 Level Triage

System Level 1 – cardiac arrest or immediate life-threatening Level 2 – significant trauma or manifest unstable

physiology Level 3 – Require 3 or more resources (i.e. lab, x-rays,

consultations, etc.) LARGEST TRIAGE GROUP Level 4 or 5 (lower acuity) - Require none or minimal

resources

RightCare ProcessRightCare Process

Nurse Practitioners/Physician Assistants – screen Level 4 and 5 patients Emergent – treated in EC Non-emergent patients are referred to Access/Financial

Counselors/Cashiers Patients provided service options

Treat in EC Treat in Urgent Care Refer to a Community Clinic or HCHD Community

Health Center• If necessary, refer patient to Eligibility Office to Establish a

Primary Care Medical Home

RightCare Process (Continued)RightCare Process (Continued)

AppropriatePatients sent

To Medical Screen

Is There a Medical

Emergency?

YES

NO

Patient is treatedIn Emergency

Center

RightCare EC ProcessRightCare EC Process

RightCare Program Fee StructureRightCare Program Fee Structure

Person 1

$150 deposit Based OnEligibility

$80

EC CareUrgent Care

Clinic Prescriptions

0

200

400

600

800

1000

1200

1400

08/06 10/06 12/06 02/07 04/07 06/07

NP/PA Screened

Non-Emergent (AccessCounselor Referred)

Screened and Non-Emergent PatientsScreened and Non-Emergent Patients

Patient Referrals to Primary Care Settings Lack of Established Eligibility Capacity Limitations

Nurse Practitioners (Ben Taub) Increase Utilization (UCC) Decrease Patient Wait Times Decrease Left Before Treatment

Frequent Fliers

RightCare ChallengesRightCare Challenges

Increase Case Management Involvement for EC High Users (4+ Visits Month) EC Clinical Case Managers, Social Work Case

Managers, EC Nursing Establish a process to provide prompt notification

of high utilizers upon arrival Minimize EC waiting times by quickly identifying

patient issues Navigate patients to appropriate community health

program

RightCare Next StepsRightCare Next Steps

The Right Care Program has not denied medical care to any patient experiencing a medical emergency

Education Continue Patient Education About Medical Home Target Level 3 Patients Largest Triage Group,

Use the Most Resources, Highest Left Before Treatment Group

RightCare Next StepsRightCare Next Steps

“Continuing to communicate the message to the community that emergency centers are not places where they should go for primary care is important. We have options for our patients, and RightCare gives

it to them.”

Dr. Thomas Granchi, Medical Director, Ginni and Richard Mithoff Trauma and Emergency Center, Ben Taub General Hospital, August 2007

Physician PerspectivePhysician Perspective

“I knew I wanted to be seen, but they told me my wait in the emergency center might be long, so I opted for theUrgent Care Center. The service was quick, and they also told me how I could go to a community clinic for follow-up.”

Urgent Care Center Patient, Ben Taub General Hospital, August 2007

Patient PerspectivePatient Perspective

QuestionQuestionss