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Avoid ED overcrowding

Patient Access Weekly Advisor, September 19, 2007

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Staff members at the Boston Medical Center (BMC) ED wouldn't settle for anything less than the answers to its overcrowding problem. Several staff members at BMC decided to take matters into their own hands by starting an intervention program to focus on frequent ED users.

The group, called the Focus Intervention Program (FIP), consists of an ED nurse manager and physician, a hospital administrator, and two outpatient social workers who devote part of their time each month to gathering details about their hospital's top 10 ED users and meet once a month to report their findings.

Rita Whelan, the administrator in the group, keeps the team together and drives the process by collecting and searching through data the group collects. She goes through the records and helps determine the most frequent users.

"Going through records, we discovered that nine out of 10 of the most frequent users were alcoholics, and the other person was homeless," says Whelan. "We also learned that a small amount of people were taking up a large amount of minutes, and not just in the ED, but on the acute side, because many of these patients would get admitted and needed to be watched."

After receiving the data and charts from Whelan, Fisher and the social workers interviewed the patients whenever possible in an effort to gain a better understanding of their situation.

By zoning in on a select number of patients and filling in a lot of the blanks in their backgrounds, Fisher says the group is better able to initiate interventions. "Our goal is to develop a care plan for these patients so they can avoid an admission to the hospital and sometimes even a trip to the ED in the first place."

During the first year of the FIP, the group reduced the amount of time that the most frequent users spent in the ED by 50%, and in 2006 that number improved to 68%. All of those minutes saved are now available for other patients with true emergent needs and, in turn, the ED is a much more time-friendly destination for consumers.

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