Strategies for Reducing ER Visits and Hospital Readmissions

1. Strategies for Reducing ER Visits and Hospital Readmissions CSI-RI Best Practice Sharing Conference March 18, 2011 Katie McGillicuddy, Quality Assistant Hillside Avenue Family & Community Medicine

2. Notification/DocumentationER, Observation and Admissions • Quality Assistant receives all hospital forms then scans and electronically links them to patient’s chart • Linked documents are automatically sent to the doc through the EHR and require the doc’s electronic signature • Less paper on doc’s desk! • Hospital admission notices go to NCM for f/u • ER admissions to QA for f/u

3. NCM OutreachAdmissions • NCM initial outreach by phone upon discharge • Determines need for office visit follow-up with NCM or MD • Goes over the Four Pillars and patient access to HFCM • Conducts Med Reconciliation as needed and refers complex issues or med list changes to MD • NCM uses note template with reportable fields for all interactions which is sent to the doc via the EMR for electronic co-signature

4. Quality Assistant OutreachEmergency Room • Contacts all patients admitted to the ER • Reminds patients about practice hours and same day visits • Asks about barriers preventing an office visit • Schedules f/u as needed • Documents information in reportable fields using a note template • Performs interventions with frequent ER visitors • Letters • NCM call/visit • Gives NCM cell phone number

5. ReportingEmergency Room • Quarterly reports capture the following information: • Name of hospital • Visit time • Date and day of the week • Payor • Reason for admission • Patient readmissions • If patient was referred by HFCM or seen for SDA • Confirmation that pt understands medical condition • Knowledge of HFCM hours/SDA policy

6. ReportingNCM note template with reportable fields NCM hospital follow-up template

7. ReportingEmergency Room ER follow-up clinical elements table

8. ReportingSample E.R. report • ER statistics by time and day of week

9. Reporting: Results ER statistics detail: reason for visit by time of day

10. Using Data To Drive Improvement Emergency Room • Finding: Largest % of ED visits occur 7P – 12A. • Discussion / Plan • Emphasize more strongly availability of on-call doctor after 7P • Publicize more widely the answering service number • Investigate the possibility of working with a local Urgent Care center to decrease evening ER visits