Hospitals participating in the Robert Wood Johnson Foundation's Aligning Forces for Quality initiative have had success reducing inappropriate emergency department use, according to an RWJF issue brief.
The issue brief outlines three lessons learned from AF4Q projects and provides examples for each:
1. Simple, gradual and targeted efforts to improve collaboration and communication with providers and patients can reduce ED use.
Example: In a project led by the Greater Detroit Area Health Council, primary care practices made changes to communicate better with patients about access to care. This effort helped reduce ED visits for primary care provider-treatable conditions from 49 visits per 1,000 patients in a four-month period to 7.3 visits in a four-month period a year later.
2. Data transparency on the use of health services can help identify avoidable ED use and the reasons behind it.
Example: The ED Care Coordination Initiative in Wisconsin uses data from the local health information exchange to identify frequent ED users, and case managers educate patients about medical homes and schedule medical home appointments. From six months before the appointment to six months after, ED use decreased 44 percent for the patients who kept these medical home appointments.
3. Engage stakeholders to take action by working with them, not just talking to them.
Example: The New Mexico Coalition for Healthcare Quality implemented an "Emergency vs. Urgency" campaign to educate people about appropriate care settings for different conditions. The campaign provided customizable materials for local health systems to use, and campaign leaders worked closely with hospital leaders. In one year, four hospitals reported an average 1,573 fewer non-emergency ED visits each.
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