Case Management

CMW sneak peek: Pilot program identifies the cause of frequent ED visits; patients overcome barriers

Case Management Weekly, November 18, 2009

University Health Care Center (UHCC) in Syracuse, NY modeled its program for handling frequent ED visitors after one established at Swedish Medical Center in Englewood, CO, says Pamela O’Donnell, RN BSN, ED case manager at UHCC. “I read an article about ED overcrowding and ‘frequent fliers’ written by Sheryl Swan, RN, at Swedish Medical Center and then adapted their program to our situation.” says O’Donnell.
 
To find the sample patient population for the pilot program, the hospital’s information technology department looked at all the ED admissions from the previous six months and compiled a list of the 50 most frequent ED visitors.
 
“Ideally, we would be able to address each of those top 50 visitors,” O’Donnell says, but instead, the committee of social workers, case managers, and directors decided to deal with a small group and evaluate the program. Based on those results, the committee would decide whether the hospital could take on a larger group.
 
The committee identified patients with PCPs in the same hospital system. It eliminated patients with sickle-cell anemia, which requires frequent ED visits, and mental health problems, which limit a patient’s ability to comply with healthcare regimens.
After applying those filters, the committee had five patients who met the hospital’s desired criteria: 
  • More than 10 visits to the ED in the past year
  • Have a PCP at UHCC (previously or currently)
  • Have no diagnosed psychiatric issues at this time 
Those five would be the prospective patients used in the Emergency Department Visit Reduction Pilot Program.
 
Check out the December 2009 issue of Case Management Monthly to learn more about condition code 44 requirements. You also can discover the benefits of becoming a Case Management Monthly subscriber.

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