Identifying emergency department regulars can improve throughput
It would be safe to say that every emergency department (ED) sees a fair share of “frequent fliers” or those patients who seem to use the ED as an alternative to other healthcare resources in the community. Knowing “the players” or the clientele of the ED can help an ED case manager address issues that affect throughput.
In the past year, we at University Hospital, Upstate Medical Center in Syracuse, NY have put together a pilot program, patterned after programs we have seen in other hospitals. The hospital generated a list of frequent fliers in the ED during the previous six month period. We identified a group of patients who not only frequent the ED but also have primary care providers within the same hospital system. We used a team approach involving case managers and social workers in the outpatient setting, to address any barriers in the patients’ lives that may cause him to use the emergency department rather than the primary care office.
The expectation was that a social worker or case manager would see the patient each time one of theses patients presented to the ED or the outpatient setting. The social worker would document the reasons for the visit as well as any interventions in a shared file in the computer. We were all able to access that information daily, and keep tabs on the progress of each patient.
The goal is not to keep patients from emergency care. Sometimes those patients presented to the ED with legitimate emergencies, but often times a different setting would have been more appropriate. In the first six months we were able to decrease the number of ED visits in all the identified patients, and we saw an increase in the number of attended visits with their primary care providers. When the hospital generated list of frequent fliers in the next six month period, over half of the original patients were no longer on the list.
I believe that the ED case manager is a crucial part of the throughput process, and knowing the clientele can only enhance the productivity and efficiency in the ED.
About the Author: Pamela O'Donnell is an ED case manager at University Hospital, Upstate Medical Center, in Syracuse, NY. While at name of facility she assisted in the development, implementation and continued evaluation of the role of the case manager in the emergency department. She defended the need for continued case management in the ED with statistical evidence. Prior to her ED case manager position, O'Donnell worked as a staff nurse in the ED and a consumer information nurse.
Alice | Sep 29, 2009 | Reply
Thanks for the article Pam. I was wondering if you would be able to share a “model” or flow chart of this pilot program. It certainly sounds like something we need to take a look at. As the Medical Appeals U.S. nurse, I see just how many “frequent fliers” we have in a given time, and a pilot like this, is long overdue for our ED.
Thanks so much!
Pam | Sep 29, 2009 | Reply
I could email you the “pilot” instructions, as well as the forms that we generated. . if that is what you are looking for. With a request to our IMT department, they were able to filter out a report with the top 50 visitors, treated and released, to the ED in a 6moth period, as well as a report with the top 50 visitors with admission following an ED visit.
Let me know. We actually patterened our pilot after a simiar study done by Swedish Hospital in Denver.
Janet | Sep 29, 2009 | Reply
Pam, I would also be interested in the instructions on your pilot program. As well everyone looking at ways to keep those frequent fliers out of the ED. Thanks
louise della bella | Sep 29, 2009 | Reply
Pam….I also would like to have the instructions
thank you
Valrie James | Oct 6, 2009 | Reply
Pam,
Would you include me in the above list. Thanks so much
suzanne warnecke | Oct 7, 2009 | Reply
Pam,
I would appreciate the pilot program info also. Please include me in the list.
Thank You!
Pru Hudson | Oct 7, 2009 | Reply
I am interested in this pilot program as well. I wonder if you would include me on your “list.” Appreciatively, Pru
Roberta | Oct 7, 2009 | Reply
Please email me th pilot program info.
Thanks
Karen Schauer | Oct 7, 2009 | Reply
Could you send me the information on the ed also.
Thanks
N Griffin | Oct 7, 2009 | Reply
Congratulations.
please share documents or other information as you can
Lisa | Oct 7, 2009 | Reply
I am also interested in documents and process chart. We have utilized care plans for frequent flyers and are looking at ways to coordinate with outpatient social services.
S. Kates | Oct 7, 2009 | Reply
I too would appreciate the model diagram or instruction.THANKS!
Shelby | Oct 7, 2009 | Reply
I am also interested in the documents you used as well. I would appreciate it very much if you could forward them to me as well.
Ginny Pisano | Oct 7, 2009 | Reply
Thank you for the information. We are working on a similar project at OSF in Peoria, IL. What are your hours of coverage for CM in your ED? Do you have both CM and SW? Ginny Pisano
Leslee Hughes | Oct 7, 2009 | Reply
I, too, am very interested in the pilot program and associated documents! Would you please pass forwrd them on to me for our facility to review..thank you so much!
M Johar | Oct 7, 2009 | Reply
Thanks for sharing your success, could you explain a little more about the shared file that everyone had access to on daily basis?
I would also appreciate a copy of your ed forms and any other process maps you might have. Have a healthy day!
Lee Ann Monilaws | Oct 7, 2009 | Reply
I would really appreciate a copy of ed forms and process maps. Thanks for sharing this valuable information.
Mary Engstrom | Oct 7, 2009 | Reply
Thanks for sharing your story. Can you explain how the shared file was used? I would be interested in seeing your pilot instructions and forms.
Coleen | Oct 7, 2009 | Reply
I’ll jump on the bandwagon for information too. Never hurts to see how others approach a common concern! We have 4 EDs but one is on a different documentation program that doesn’t “talk” to the others. We’re trying to prevent hopping while reducing visits.
Thanks for sharing your experience.
Angela | Oct 7, 2009 | Reply
I would also appreciate a copy of the forms and process maps. Thank you for sharing.
Rosemary | Oct 7, 2009 | Reply
As a Social Worker / Discharge Planner based in an ER, I have looked a this same issue and have had conversations with “regular patients” about alternatives for care. Most do not have a primary physician but have established our ER as such. I will appreciate a copy of your pilot guidelines. Thank you.
Cathy | Oct 7, 2009 | Reply
I would appreciate a copy of all forms and process maps. We too have a huge number of “regular patients” who are seen several times each month in the ED. Thanks for sharing.
Theresa Brocato | Oct 7, 2009 | Reply
Thanks for sharing this information. We have a similar program here, called “Care Partners”. We utilize a community health worker (CHW) to identify these patients, particularly the uninsured. The CHW assists them to find medical homes, access to medications and other community resources. They also assist with Medicaid applications.
Dianna Sloan | Oct 7, 2009 | Reply
As an RN/Case Mgr in the ED I would be very interested in receiving the forms etc.
Lourdes Geslani | Oct 7, 2009 | Reply
It would be great if we can get copies of the forms and process maps as well. Thank you
Pat | Oct 7, 2009 | Reply
We are thinking of trying ER case management, and I would appreciate any maps, forms etc that would help us along this process. Thank you very much.
Selina J. Rushing | Oct 7, 2009 | Reply
Pam,
This is very interesting. We are not on Electronic Medical Documentation at this time. Our IT department is working on it, we are hoping to be ready to go by January 2010. This will be of great use to us. Please add me to your list.
Thank You, Selina
Linda Ferara | Oct 7, 2009 | Reply
Pam,
Could you add me to your list of people to recieve a copy of the forms, etc in the pilot program you are doing. It sounds very interesting and I would like to see if we could try this here. Thank you Linda
Lisa Anderson | Oct 8, 2009 | Reply
Pam,
Would you please add me to your list of people to receive a copy of the pilot project? Thank you, Lisa
Beth Cobb | Oct 8, 2009 | Reply
Pam,
It sounds like you have developed a great program. I would also be interested in receiving a copy of the pilot instructions and forms generated.
Thank you, Beth
Noel Lemke | Oct 8, 2009 | Reply
I am an ED Case Manager/Social worker. Please include me in your list as well, your program sounds great!
Jean Foster | Oct 9, 2009 | Reply
Pam, Please email me the info also…it sounds like there is a lot of interest in this area! Also, What resources did you use to develop your program (articles?). Thanks for the info.
Rebecca | Oct 9, 2009 | Reply
Pam, I would love to have any resources that you have to offer also. We struggle with the patients that return repeatedly, not due to lack of PCP, but lack of diet and medication compliance. Any suggestions for that group?
Kelley | Oct 10, 2009 | Reply
We have an ED case management program at our hospital, as well. It is in it’s second year, so we are still tayloring it to the needs of our ED. We also have recidivist patients who frequent our ER. We too try to talk with these pts at the time of their ED visit to try to determine what barriers are repeatedly bringing them back to the ED. We also have a report that our IT dept. generates for us that shows patients that return within 72 hrs to the ED. We contact these pts via telephone for follow-up. We used to look at 30 days, but changed it to 72 hours based on current literature that we had reviewed. But, I will say that the problem is much bigger than just 72 hour recidivism. I recently had our IT dept to run a report that listed the ED patients seen quarterly, and it was amazing how many were repeat offenders. I would also be interested in the particulars of your program, as well as, the paperwork that you use, since our program is still young and we are still revising and changing things to meet our needs. I will say that the staff and physicians do utilize case managment services much more frequently in the year that I have been on the job. One problem that we do encounter, however, is consistent treatment between physicians for these patients. This sometimes makes it difficult to re-inforce the plan of care for the patient. Any suggestions for how you have managed this issue in your ED.
Stacey McClain | Oct 12, 2009 | Reply
I, too would love to see your information on your program.
Sally Dunn | Oct 12, 2009 | Reply
Hi Pam,
Would you mind sending me the instructions and forms related to your pilot? I’m very interested in hearing more about your pilot project-
Denise Haye | Oct 13, 2009 | Reply
We are beginning to look at our frequent flyer issue in the ED and are focusing on diabetes, sickle cell, and psychosis as these are our top defenders. Our idea is to introduce a health coach concept in conjunction with social work and behavioral health interventions. I am looking for any process flow, forms, or anything that has been used by others sucessfully, so we can tweek to meet our needs. Can you share your process flow and any documents used to improve your outcomes? Thanks. Denise
Shane | Oct 14, 2009 | Reply
Hi Pam,
Could you also send me the info! Thanks
Dianne Murphy | Oct 14, 2009 | Reply
Pam,
As Registration Services Manager, I would also like a copy of the forms and process maps that might be of help to our small rural hospital. We average seeing about 1200 E.R. patients a month and have frequent flyers. Thanks for sharing your process.
Stephanie Smithson | Oct 14, 2009 | Reply
Hi Pam,
Thank you for sharing your story. I would also like a copy of the forms and process maps.
Christine Sherrill | Oct 14, 2009 | Reply
Pam: I would also appreciate information regarding your program. Thanks so much
Brett | Oct 15, 2009 | Reply
It would be terrific to have this info. Please add me to the list. Thank you!
Heather Murphy | Oct 16, 2009 | Reply
Please add me to the list! I would love to see a copy of the forms and process maps. Thank You!
Elizabeth Gordon | Oct 20, 2009 | Reply
Please add me to your list. This is such a problem area for everyone. I would like to see a copy of the forms and other items that you are sharing with the others. Thank you.
Lynn Manahan | Oct 21, 2009 | Reply
I would also like a copy of the tools developed to address this common issue. I’ve searched for templates online and the original Swedish study, to no avail. Thanks for sharing your pilot findings with the group!
Kelly Isidore | Oct 21, 2009 | Reply
Please send me a copy also. I have just inherited the ED Case Managers and am also wondering are there any seminars out there that are available?
Diane Cline | Oct 28, 2009 | Reply
Please send a copy of the pilot forms you are using for your emergency department frequent flyers. Thanks
Rebecca | Oct 29, 2009 | Reply
Hi Pam-
Questions:
1) Why did you focus on those that were already receiving care from PCP’s in the hospital system? (i.e. easier for statistical reasons?). What would you do about those people who are not with a PCP within the hospital system, say those with medicaid insurance?
2) When you stated you were utilizing outpatient case managers/social workers, were they from your hospital or other agencies? If form other agencies, which ones and were the patients already hooked up with them?
3) Any advice on how to assit the chronic alcoholic who refuses treatment but is picked up daily by EMS for being extremly intoxicated laying on the street?
I would also like a copy of your pilot forms. Thanks for your article and any input you have on the above!
Peggy Kopp | Nov 2, 2009 | Reply
Pam, Please send a copy of your pilot forms. I would like to see how this could be implemented in a small facility.
Thank you
Kathy Bowen | Nov 4, 2009 | Reply
i am interested in your pilot forms. I am a new case manager in a small community/rural hospital under 100 beds.
We just opened a new ER with 20 beds
Sally Daggy | Nov 4, 2009 | Reply
Thank you for sharing your program. I am interested in learning more about the details. Please forward forms and information so I may review. Hopefully we can better utilize our ED.
Vickie Bell-Wilson | Nov 6, 2009 | Reply
Hello Pam. I read with great interest your posting concerning the ED frequent fliers. I also would like to receive any information you can share with me. Thank you very much.