ER is for Emergencies

Reducing Avoidable Emergency Department Visits

ER Utilization

Emergency rooms are an integral department in our health care systems, providing immediate access for acute illness, accidents, and trauma. Over the last decade, data on ED visits grew exponentially, yielding more than 137 million visits, and while cost estimates vary across the nation, an estimated 39 billion/annually can be associated with these visits.

While emergent care necessitates a visit to an Emergency Department, there are some circumstances that could be avoidable and appropriately managed in urgent care centers, physician offices and clinics.

Additionally, avoidable ED visits may be indicative of lack in care coordination or management, lack of access and information on where to receive care in the community.

ER is for Emergencies and the 7 Best Practices Program

In 2012, The Washington State Hospital Association (WSHA), in a collaborative partnership with the Washington State Medical Association (WSMA) and the WA State Chapter of the American College of Emergency Physicians developed a program: ER is for Emergencies-The 7 Best Practices.

This program was developed to redirect clinical care or low acuity illness to the most appropriate setting and reduce preventable Medicaid emergency room visits.

Now, a decade later, WSHA continues to support hospitals in sustaining patient-centric care, leveraging the 7 Best Practices to identify patients with 5 or more emergency department visits to the same facility per calendar year.  Identifying patient-centric care needs, such as poorly managed chronic medical conditions, substance use, lack of primary care access, health-related social needs and assessing the ability to link to appropriate care and community resources for patients in our respective communities will be important for reducing avoidable ER use.

Getting Started:

Be familiar with the WA State Legislative language: Third Engrossed Substitute House Bill 2127 and the ER is for Emergencies 7 Best Practices. Ensure that these strategies have been implemented at your facility.  

The 7 Best Practices

1. Electronic Health Information
   • Adoption of an electronic health information exchange system on a statewide basis to create and act on a common, integrated plan of care related to patients with potentially avoidable visits to the emergency department. This electronic communication tool is the common space for hospital-based care teams, primary care providers, mental health teams and clinics supporting unique patient -centric care.
2. Patient Education
   • Develop and disseminate patient education materials that support access and utilization of appropriate care resources. Ensure that this information illustrates community-based care sites such as clinics, urgent care and non-acute care sites that provide off-hour services. Additionally, provide these educational materials in a format that supports your community’s language and cultural preferences.
3. Identify Frequent Users of the Emergency Department and EMS
   • Hospitals should identify emergency department visit history upon arrival and coordinate case management for patients that have 5 or more visits to the same emergency room within the last 12 months.  Utilize a care management team to assess the drivers of utilization, both clinical and social, to develop unique care plans with patients, re-visit plans with hospital team members.
4. Develop Patient Care Plans for Frequent ER Users
   • Hardwire a standard process to identify frequent emergency department utilizers and create accountability for this task.  Consider creating a step in your patient interview process to collect data on social factors that may be drivers of their ED visits.  Several tools exist to assess patient health-related social needs or social determinants of health. AHA Screening for Social Needs
5. Narcotic Guidelines
   • Reduce drug -seeking and drug-dispensing behaviors by implementing guidelines that incorporate the WA-ACEP guidelines.
     • https://wahealthalliance.org/wp-content/uploads/2017/01/Opioid-Prescribing-Guidelines-for-Providers.pdf
     • CDC Opioid Prescribing Opioids for Pain
     • Opioid Prescribing in Older Adults
6. Prescription Monitoring
   • The state’s Prescription Monitoring Program is an electronic online database used to collect data on patients who are prescribed controlled substances ensuring coordination of prescription drug prescribing practices.
7. Use of Feedback Information
   • Engage your hospital emergency, care management and quality teams in reviewing your ED Utilization Reports. Consider a point person to track utilization data (report of multi-visit patients on a daily or weekly basis. Ensure interventions are implemented, working and that there is a process of reporting to executive leadership.

Engage WSHA often to learn more about what you are learning from your avoidable ED visits, barriers in patients receiving care in your community and social aspects or drivers that are occurring in your hospital. Together, we can strengthen our aim and improvement to best support our communities in receiving appropriate care, in the right place and at the right time. Contact Tina Seery (TinaS@wsha.org) for questions.

Tools

• Seven Best Practices
• Badges and posters can be ordered through the WSHA Bookstore Emergency Items Section.

Resources

• Care Coordination: AHRQ Preventable Emergency Room Visits
• Emergency Department Utilization | Collective Medical | Collective Medical
• Emergency Room Visits
• Third Engrossed Substitute House Bill 2127
• Best Practice FAQ Sheet
• Washington Health Alliance (wahealthalliance.org)
• WA State Prescription Monitoring Program

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