All Entries Tagged With: "ED overcrowding"

Is H1N1 hype clogging your ED?

Is it a cold or something worse?

The nightly news is teaming with stories about seemingly healthy young people becoming critically ill from the H1N1 virus, and people are worried.

I am no exception. When I hear a coworker cough of sniffle, I get a little uneasy. I have been able to stay healthy during this young flu season. However, should I find myself running a fever and coughing, my unease might turn to worry. And where do most folks go when they are worried about their health? The doctor, or if they can’t wait for an appointment, the ED.

EDs are crowded as is. The last thing ED staff members need is people presenting to the ED that are afraid their head cold could kill them. That is why Emory University and Microsoft have teamed up to create a the H1N1 (Swine Flu) Response Center.

The H1N1 (Swine Flu) Response Center is a Web-based assessment tool that asks site visitors a series of questions, including:

• Age
• Gender
• Geographic location
• Severity of symptoms
• Length of symptoms

After answering these questions, users receive symptom management advice. In severe cases, the tool instructs users to consult a physician immediately. In less severe scenarios, the tool may instruct users to visit a walk-in clinic or stay in bed and drink fluids.

Site sponsors hope people with less severe symptoms will use this tool’s advice instead of visiting the ED, but is it enough? Some folks might be satisfied by this tool opinion, but others might not trust the advice, after all, there is no better cure for worry than the clinical judgment of a real, live healthcare professional, right.

Tell us about what is going on at your facility. Is your ED crowed with people with flu symptoms, looking for a little reassurance that they are not facing peril? Has your facility developed a system to handle the expected surge in visitors?

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.

University of Chicago’s ED diversion plan scrutinized

The American College of Emergency Physicians says the University of Chicago Medical Center’s (UCMC) new diversion plan for its ED—moving patients with non-urgent needs to community hospitals and clinics—comes dangerously close to violating the Emergency Medical Treatment and Active Labor Act (EMTALA).

EMTALA dictates that hospital emergency departments provide emergency treatment to patients, regardless of the patients’ ability to pay. The complaint comes afterUCMC sent a patient who was attacked by a pit bull to another hospital for surgery. The American College of Emergency Physicians argues this practice comes dangerously close to “patient dumping.”

But UCMC maintains that its program is designed to treat patients at the appropriate location in a tough economic atmosphere.

Source: Chicago Tribune

Do you consider UCMC's program to be patient dumping?

Solutions in the ED: Add-on or value-added?

A few weeks ago, a hospital system that is experienced in failed attempts at reducing non-emergent emergency room visits asked me why people keep coming back to the emergency department (ED). I reflected back on observations over the past eight years and came up with this response:  People keep coming back to the ED because patients tend to be viewed most often in terms of “symptoms and acuity.”  [more]

CMW Tip of the Week: Investigate transportation options for patients from the ED

This week’s tip comes from Kathleen Walsh, RN, MS.

Many patients are brought to the ED by ambulance or dropped off by a friend or family member and do not have transportation home once medically cleared. For these patients, the case manager could try, with the patient’s help, to call family, friends, or neighbors for assistance. Some EDs offer bus or subway tokens, or prearranged taxicab company vouchers. For others, developing contracts with local ambulance companies for chair-van services at a reduced rate is helpful.

Investigate whether a hospital ATM machine could be used by the patient to secure cash for a cab or whether the patient/family will be able to pay a cab with cash at home.

Have a tip or tool you’d like to share? Or maybe a question for our experts? E-mail it to editor Julie McGinley at jmcginley@hcpro.com.Your thoughts could be featured in the next issue of Case Management Weekly!

CMW Sneak Peek: Eliminate ED Overcrowding

ED overcrowding is a problem almost every hospital faces. Many patients inappropriately come to the ED for nonurgent issues, but, by law, the ED is required to treat everyone. This puts hospitals in the difficult situation of having to care for all patients safely and efficiently.

Peter Moran, RN, C, BSN, MS, CCM, case manager at Massachusetts General Hospital in Boston, says his ED has been working diligently on resolving overcrowding issues during the past two years. “We’re running into systems issues and operational issues, and we’re trying to pinpoint where the problems are,” Moran says.

Moran’s facility has implemented the following strategies:

• Have a physician present during triage. “Patients used to come in, they’d register, they’d be seen at triage, and then they’d wait to be seen by a physician,” Moran says. “Now, when patients register at triage, they’re seen and examined by a physician who then does a preliminary exam and orders initial testing.” When patients enter the waiting room, some workup has already been done, which gives patients a head start with their care.
• Train case managers to recognize patients requiring other levels of care. “We try to have expedited referrals for patients that can be diverted to other levels of care,” Moran says. The case managers will call screeners from other facilities, such as long-term acute care hospitals (LTACH), to move patients out of the ED, when appropriate.

Check out the January 2008 issue of Case Management Monthly to get the full story, and discover all the benefits of being a Case Management Monthly subscriber!