ED Community Placement Project “Right Service-Right Venue” recidivism reduction.

2.50
Hdl Handle:
http://hdl.handle.net/10755/344135
Category:
Abstract
Type:
Poster
Title:
ED Community Placement Project “Right Service-Right Venue” recidivism reduction.
Author(s):
Mitchell, Karen
Lead Author STTI Affiliation:
Non-member
Author Details:
Karen Mitchell, MSN,RN,CNE,CMCN, kemitchell@ucsd.edu
Abstract:
Evidence-based Practice Abstract Purpose: Background: San Diego has the 3rd largest homeless population in the United States, following New York and Los Angeles. Homeless patients without medical homes account for nearly 1/3 of the ED visits, resulting in longer ED wait times and avoidable inpatient admissions. Staff morale is adversely affected as a result the “frequent flyer’ phenomenon. Emergency departments (ED) are ill equipped to meet the psychosocial, housing, substance abuse treatment and mental health needs of homeless community. Purpose: To examine the effects of an innovative evidence based project placing the ED highest frequent users to contracted hospital leased beds in community homeless prevention partners specializing in substance abuse treatment and recuperative care. Design: Design: This evidence based practice project is nurse developed and driven, multidisciplinary, and community collaborative. This highest ED utilizers are placed (upon discharge) to hospital funded leased beds in community agencies that specialize in homeless prevention strategies, substance abuse treatment, and intensive case management. Emergency department led, this, 6-month, 2 phase pilot has developed new safe and effective discharge options bridging this vulnerable population to better care options, thus reducing ED readmissions. Setting: Setting: Urban, inner-city Emergency Department, academic teaching healthcare facility. In 2012 provided treatment of more than 42K patient’s. Participants/Subjects: Participants/Subjects: Participants were electronically pre-identified in EPIC electronic medical records. 215 targeted patients/participants were identified based on excessive ED utilization. The “highest utilizer” criterion was based on 2 more ED visits per month over 12 months. Inclusion criteria consisted of non-funded underinsured homelessness with associated complaints of co-occurring disorders, substance abuse and alcohol related illness. Pilot time frame during Phase II, was over a 6 month period. Methods: Methods: Upon patient presentation to the ED the Best Practice Advisory (BPA) flag is initiated and triggers an “ED Community Placement Order” The ED physician/psychiatrist places the order and indicates which placement option is best suited for placement. The participant consenting, interviewing and placement (to community partners) are performed by ED Staff. Results/Outcomes: Results and Outcomes: Results: The goal for this project is to reduce recidivism amongst the neediest and costliest patients by 20% through provision of resources to address substance abuse, homelessness and mental health issues. Six month analysis: Cost savings of $168,231. Based on program expenses, (contractual bed cost) of $38,234 (6mos) = 4 .4 (ROI). 78 % reduction in ED visits among EDCPP placed patient cohort. 3.8% increase in Press-Ganey patient satisfaction scores. Implications: Other benefits from this project include improvement in ED thru put and reduction wait times, approval for Phase II and the acquisition of additional community beds. Implications for further nursing research are far reaching. Given the results, this program is planned for expansion to sister healthcare systems. This pilot is intended as a structural framework for other at risk populations who may benefit from community collaboration to reduce admission.
Keywords:
ED recidivism reduction; community placement of frequent ED users; Frequent ED users
Repository Posting Date:
4-Feb-2015
Date of Publication:
4-Feb-2015
Conference Date:
2014
Conference Name:
2014 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Indianapolis, Indiana, U.S.A.
Description:
2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleED Community Placement Project “Right Service-Right Venue” recidivism reduction.en_GB
dc.contributor.authorMitchell, Karenen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsKaren Mitchell, MSN,RN,CNE,CMCN, kemitchell@ucsd.eduen_GB
dc.identifier.urihttp://hdl.handle.net/10755/344135-
dc.description.abstractEvidence-based Practice Abstract Purpose: Background: San Diego has the 3rd largest homeless population in the United States, following New York and Los Angeles. Homeless patients without medical homes account for nearly 1/3 of the ED visits, resulting in longer ED wait times and avoidable inpatient admissions. Staff morale is adversely affected as a result the “frequent flyer’ phenomenon. Emergency departments (ED) are ill equipped to meet the psychosocial, housing, substance abuse treatment and mental health needs of homeless community. Purpose: To examine the effects of an innovative evidence based project placing the ED highest frequent users to contracted hospital leased beds in community homeless prevention partners specializing in substance abuse treatment and recuperative care. Design: Design: This evidence based practice project is nurse developed and driven, multidisciplinary, and community collaborative. This highest ED utilizers are placed (upon discharge) to hospital funded leased beds in community agencies that specialize in homeless prevention strategies, substance abuse treatment, and intensive case management. Emergency department led, this, 6-month, 2 phase pilot has developed new safe and effective discharge options bridging this vulnerable population to better care options, thus reducing ED readmissions. Setting: Setting: Urban, inner-city Emergency Department, academic teaching healthcare facility. In 2012 provided treatment of more than 42K patient’s. Participants/Subjects: Participants/Subjects: Participants were electronically pre-identified in EPIC electronic medical records. 215 targeted patients/participants were identified based on excessive ED utilization. The “highest utilizer” criterion was based on 2 more ED visits per month over 12 months. Inclusion criteria consisted of non-funded underinsured homelessness with associated complaints of co-occurring disorders, substance abuse and alcohol related illness. Pilot time frame during Phase II, was over a 6 month period. Methods: Methods: Upon patient presentation to the ED the Best Practice Advisory (BPA) flag is initiated and triggers an “ED Community Placement Order” The ED physician/psychiatrist places the order and indicates which placement option is best suited for placement. The participant consenting, interviewing and placement (to community partners) are performed by ED Staff. Results/Outcomes: Results and Outcomes: Results: The goal for this project is to reduce recidivism amongst the neediest and costliest patients by 20% through provision of resources to address substance abuse, homelessness and mental health issues. Six month analysis: Cost savings of $168,231. Based on program expenses, (contractual bed cost) of $38,234 (6mos) = 4 .4 (ROI). 78 % reduction in ED visits among EDCPP placed patient cohort. 3.8% increase in Press-Ganey patient satisfaction scores. Implications: Other benefits from this project include improvement in ED thru put and reduction wait times, approval for Phase II and the acquisition of additional community beds. Implications for further nursing research are far reaching. Given the results, this program is planned for expansion to sister healthcare systems. This pilot is intended as a structural framework for other at risk populations who may benefit from community collaboration to reduce admission.en_GB
dc.subjectED recidivism reductionen_GB
dc.subjectcommunity placement of frequent ED usersen_GB
dc.subjectFrequent ED usersen_GB
dc.date.available2015-02-04T11:27:07Z-
dc.date.issued2015-02-04-
dc.date.accessioned2015-02-04T11:27:07Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationIndianapolis, Indiana, U.S.A.en_GB
dc.description2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
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