2.50
Hdl Handle:
http://hdl.handle.net/10755/162458
Type:
Presentation
Title:
Emergency Department Case Management: Gatekeeper Role
Abstract:
Emergency Department Case Management: Gatekeeper Role
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Swan, Sheryl L., RN, BSN, CCM
P.I. Institution Name:Swedish Medical Center
Title:Case Manager, Emergency Services
Contact Address:, Englewood, CO, 80113-, USA
Contact Telephone:(303) 788-6040
Purpose: Emergency department case managers can be gatekeepers for the recognition and management of interventions with high profile, resources-draining patients. Positive outcomes include decreased length of stay, decreased organizational financial loss, and improved community collaboration. The purpose of this study is to outline steps needed to establish a gatekeeper programs highlighting focused interventions with chronic pain patient and the drug/seeking fraud population.

Design: A retrospective review of ED visit history of patient in the program are trended pre and post intervention with actual uncollected charges in a cost avoidance study.

Setting: An urban level 1 trauma center and free standing suburban full service emergency department with a combined census of approximately 66,000 per year.

Participants/Subjects: Data were evaluated for 355 self-pay adult patients records having 2 or more repeat ED visits for minor complaints. Records for chronic pain patients with self pay status (mean n=119) from 1999 through 2005.

Methodology: ED patient population is reviewed to understand: (1) patient demographics, (2) dynamics of census such as peak utilization times and length of stay, (3) common barriers to receiving care, such as insurance, language, functional and cognitive status and accessibility to primary care, (4) diagnoses and medical histories. These data are reviewed to identity "high profile" because they create barriers to ED throughput, they consume unusually high amounts of resources or they present a financial or compliance risk to the hospital.

Results: Actual cost avoidance in the past seven years has averaged to be $131,838.56 for an averaged sample size of 119 patients. Projected cost avoidance average for case management gatekeeper $270,489.65. 55% of self-pay visits were classified as semi-urgent or non-urgent. 70% of those visits following clinical intervention had no repeat visits with an average savings/patient of $222,757,59.

Conclusion: ED staff member are educated to recognize the specific patient populations, to understand the goals of care plans, and community resources. The goals of ED gatekeeper are cost avoidance and access to the appropriate level of care and service to all ED patients. The outcomes measured and evaluated are: (1) Quality care- prevents adverse occurrences, eliminates care fragmentation, (2) Fiscal responsibility- prevents unnecessary admissions, cost efficient care in use of appropriate level of care, (3) Patient advocacy-personal attention in a large complex and impersonal health care system (4) Outpatient Management- community based service matching patient needs and financial capability, (5) Profession nurse practice- proactively finding solutions to problems facing the health care system.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleEmergency Department Case Management: Gatekeeper Roleen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162458-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Emergency Department Case Management: Gatekeeper Role</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2008</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Swan, Sheryl L., RN, BSN, CCM</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Swedish Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Case Manager, Emergency Services</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Englewood, CO, 80113-, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(303) 788-6040</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Sheryl.Swan@healthonecares.com</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Emergency department case managers can be gatekeepers for the recognition and management of interventions with high profile, resources-draining patients. Positive outcomes include decreased length of stay, decreased organizational financial loss, and improved community collaboration. The purpose of this study is to outline steps needed to establish a gatekeeper programs highlighting focused interventions with chronic pain patient and the drug/seeking fraud population. <br/><br/>Design: A retrospective review of ED visit history of patient in the program are trended pre and post intervention with actual uncollected charges in a cost avoidance study. <br/><br/>Setting: An urban level 1 trauma center and free standing suburban full service emergency department with a combined census of approximately 66,000 per year. <br/><br/>Participants/Subjects: Data were evaluated for 355 self-pay adult patients records having 2 or more repeat ED visits for minor complaints. Records for chronic pain patients with self pay status (mean n=119) from 1999 through 2005. <br/> <br/>Methodology: ED patient population is reviewed to understand: (1) patient demographics, (2) dynamics of census such as peak utilization times and length of stay, (3) common barriers to receiving care, such as insurance, language, functional and cognitive status and accessibility to primary care, (4) diagnoses and medical histories. These data are reviewed to identity &quot;high profile&quot; because they create barriers to ED throughput, they consume unusually high amounts of resources or they present a financial or compliance risk to the hospital. <br/><br/>Results: Actual cost avoidance in the past seven years has averaged to be $131,838.56 for an averaged sample size of 119 patients. Projected cost avoidance average for case management gatekeeper $270,489.65. 55% of self-pay visits were classified as semi-urgent or non-urgent. 70% of those visits following clinical intervention had no repeat visits with an average savings/patient of $222,757,59. <br/><br/>Conclusion: ED staff member are educated to recognize the specific patient populations, to understand the goals of care plans, and community resources. The goals of ED gatekeeper are cost avoidance and access to the appropriate level of care and service to all ED patients. The outcomes measured and evaluated are: (1) Quality care- prevents adverse occurrences, eliminates care fragmentation, (2) Fiscal responsibility- prevents unnecessary admissions, cost efficient care in use of appropriate level of care, (3) Patient advocacy-personal attention in a large complex and impersonal health care system (4) Outpatient Management- community based service matching patient needs and financial capability, (5) Profession nurse practice- proactively finding solutions to problems facing the health care system.</td></tr></table>en_GB
dc.date.available2011-10-27T10:28:34Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:28:34Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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