2.50
Hdl Handle:
http://hdl.handle.net/10755/163009
Type:
Presentation
Title:
Emergency Department-specific Case Management
Abstract:
Emergency Department-specific Case Management
Conference Sponsor:Emergency Nurses Association
Conference Year:2005
Author:Fitzgibbon, Laurie, RN, BSN, CEN
P.I. Institution Name:Aultman Health Foundation
Title:Patient Care Specialist/Case Manager
Contact Address:2600 Sixth Street SW, Canton, OH, 44710 - 1702, USA
Contact Telephone:(330) 363-5846
Co-Authors:Liz Edmunds, RN, MSN
Purpose: Increased use of the emergency department (ED) for non-emergent visits results in ED overcrowding, increased length of stay, and poor utilization of health care dollars. The purpose of this project was to implement an ED specific case management program to reduce utilization of non-emergent visits through enhanced patient education and providing linkages to primary care providers and community resources. Design: Implementation of a performance improvement project for ED-specific case management. Setting: An urban, Level II trauma center with 75,000 annual visits. Subjects: At-risk patients targeted for case management were defined and supported by review of literature and analysis of ED non-emergent patient demographics. A literature search revealed patients at-risk for fragmented healthcare included those without a primary care provider, those without health benefits, and those on Medicaid. An analysis of ED utilization for non-emergent visits in this facility correlated with literature findings. Non-emergent is defined by this institution's reimbursement coding scale, specifically, evaluation and management levels I and II. Methods: Implementation of the RN case manager role included identification of at-risk populations for fragmented healthcare. Networking with hospital and community resources to develop ways to meet the healthcare and social needs of at-risk populations was completed. Education of nursing staff, liaisons, and ED physicians of available resources and ED-specific case management principles, including enhanced patient education was implemented. Results: Evaluation of at-risk population visits shows a decrease in non-emergent visits by 34% (N=6852) in 2004. A 2004 focus study showed that of 1062 patients referred to this institution's outpatient clinic 32% (n=339) made an appointment. From this, 91% (309) them kept their appointments. This study reinforces the need to schedule follow-up appointments while the patient is in the emergency department. A 2004 focus study of 50 random patients who received 1:1 case manager education revealed that 60% (n=30) had no return visits; 26% (n=13) had one return visit; 8% (n=4) had two return visits; and 6% (n=3) had three return visits. A random study of 50 patients who qualified to receive staff case management education revealed 58% (n=29) had no return visits, 20% (n=10) had one, 4% (n=2) had two, 6% (n=3) had three, and 12% (n=6) had four or more return visits. The finding of similar "no return visits" between staff and case manager suggest case management staff education was effective. However, the increase in two or greater visits may be related to the inability of staff to schedule follow-up appointments on the off-shift and possible inconsistency of patient case management education by staff. Recommendations: Limitations identified conclude the need for consistency by staff in case management patient education and the ability of staff to schedule follow-up appointments. Subsequent actions will include the development of an ED Case Management Core Team, thereby giving case management 24/7 coverage. As the ED continues to be the "safety net" for at-risk populations, implications for expanding the ED-specific case management program to include individualized patient care plans is indicated.
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-specific Case Managementen_GB
dc.identifier.urihttp://hdl.handle.net/10755/163009-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Emergency Department-specific Case Management</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">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Fitzgibbon, Laurie, RN, BSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Aultman Health Foundation</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Patient Care Specialist/Case Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2600 Sixth Street SW, Canton, OH, 44710 - 1702, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(330) 363-5846</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">lfitzgibbon@aultman.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Liz Edmunds, RN, MSN</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Increased use of the emergency department (ED) for non-emergent visits results in ED overcrowding, increased length of stay, and poor utilization of health care dollars. The purpose of this project was to implement an ED specific case management program to reduce utilization of non-emergent visits through enhanced patient education and providing linkages to primary care providers and community resources. Design: Implementation of a performance improvement project for ED-specific case management. Setting: An urban, Level II trauma center with 75,000 annual visits. Subjects: At-risk patients targeted for case management were defined and supported by review of literature and analysis of ED non-emergent patient demographics. A literature search revealed patients at-risk for fragmented healthcare included those without a primary care provider, those without health benefits, and those on Medicaid. An analysis of ED utilization for non-emergent visits in this facility correlated with literature findings. Non-emergent is defined by this institution's reimbursement coding scale, specifically, evaluation and management levels I and II. Methods: Implementation of the RN case manager role included identification of at-risk populations for fragmented healthcare. Networking with hospital and community resources to develop ways to meet the healthcare and social needs of at-risk populations was completed. Education of nursing staff, liaisons, and ED physicians of available resources and ED-specific case management principles, including enhanced patient education was implemented. Results: Evaluation of at-risk population visits shows a decrease in non-emergent visits by 34% (N=6852) in 2004. A 2004 focus study showed that of 1062 patients referred to this institution's outpatient clinic 32% (n=339) made an appointment. From this, 91% (309) them kept their appointments. This study reinforces the need to schedule follow-up appointments while the patient is in the emergency department. A 2004 focus study of 50 random patients who received 1:1 case manager education revealed that 60% (n=30) had no return visits; 26% (n=13) had one return visit; 8% (n=4) had two return visits; and 6% (n=3) had three return visits. A random study of 50 patients who qualified to receive staff case management education revealed 58% (n=29) had no return visits, 20% (n=10) had one, 4% (n=2) had two, 6% (n=3) had three, and 12% (n=6) had four or more return visits. The finding of similar &quot;no return visits&quot; between staff and case manager suggest case management staff education was effective. However, the increase in two or greater visits may be related to the inability of staff to schedule follow-up appointments on the off-shift and possible inconsistency of patient case management education by staff. Recommendations: Limitations identified conclude the need for consistency by staff in case management patient education and the ability of staff to schedule follow-up appointments. Subsequent actions will include the development of an ED Case Management Core Team, thereby giving case management 24/7 coverage. As the ED continues to be the &quot;safety net&quot; for at-risk populations, implications for expanding the ED-specific case management program to include individualized patient care plans is indicated.</td></tr></table>en_GB
dc.date.available2011-10-27T10:37:58Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:37:58Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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