In January 2012, St. Luke's Hospital in Cedar Rapids, part of Des Moines-based Iowa Health System, embarked on an initiative to reduce patients' non-emergency visits to the emergency department. Under St. Luke's ED Consistent Care Program, a committee of providers develops personalized care plans for patients, coordinates care with physicians and educates patients on appropriate sites of care for different situations. In the first nine months of the program, St. Luke's reduced the number of ED visits by frequent ED users by more than two-thirds, generating more than $970,000 in savings. Based on its success, Iowa Health System is considering expanding the initiative system-wide.
ED Consistent Care Program
The Consistent Care Program began as a pilot project supported by a $50,000 grant from Transamerica. In January 2012, a committee that includes two ED physicians, three nurses, an ED social worker, a social work case manager and the ED director identified 103 patients who had visited the ED more than 12 times in the previous 12 months. Patients are added to the program on a rolling basis throughout the year.
The committee contacts the patients and develops the initial care plan that includes a list of the patients' reasons for their past ED visits and the care provided. If the patients sign the release of information, the committee contacts their primary care providers for their input on the ED care plan. If a patient does not have a primary care provider, the case manager finds one for the patient. The case manager always follows up with patients after their first primary care physician visit to determine their comfort level with the physician and ease of access. The case manager also follows up with the physician to discuss any concerns and plans for care.
Patients are categorized into one of more than six tracks based on the most frequent cause of their ED visits, such as general pain, back pain, abdominal pain or behavioral health. There is also a track for elderly patients. The tracks help the hospital team and primary care provider create a care plan that is tailored to each patient's needs. While all patients' care plans include a prohibition of discharge with narcotics, the care plans differ based on specific protocols determined jointly by the primary care provider and program committee.
Coordinating with the primary care provider
A key element of the Consistent Care Program is the hospital's coordination with patients' primary care providers. "It's rooted in the belief that primary care physicians are the key component to a person's ongoing medical care," says Sallie Selfridge, case manager for the program. "[Partnering with primary care physicians] is consistent with Iowa Health System's vision, which is delivering the best outcome for every patient every time."
Agreeing on a standard plan of care for patients creates consistency, which lowers the risk of adverse events and improves efficiency. For example, a primary care physician shared a protocol for a patient with migraines with the program's committee. If the patient came to the ED, she would receive care consistent with care she would receive at the primary care physician's office. "That communication between the primary care physician and hospital is a more holistic approach and provides consistency, which is one of the key parts of our program," says Ms. Selfridge.
Removing barriers to appropriate care
In addition to ensuring patients receive consistent care when presenting to the ED, the Consistent Care Program helps patients remove barriers to seeking care in the most appropriate place, whether the issue is transportation, insurance or lack of awareness of options. As the case manager, Ms. Selfridge helps patients find a primary care physician and arranges for transportation to physician appointments.
Ms. Selfridge also educates patients on healthcare resources available in the community, such as walk-in clinics, and discusses patients' responsibility for their care. For example, she explains patients' need to attend regular wellness checkups, follow medication instructions and make healthy choices. This education helps to empower patients to take charge of their healthcare, according to Ms. Selfridge.
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ED Consistent Care ProgramThe Consistent Care Program began as a pilot project supported by a $50,000 grant from Transamerica. In January 2012, a committee that includes two ED physicians, three nurses, an ED social worker, a social work case manager and the ED director identified 103 patients who had visited the ED more than 12 times in the previous 12 months. Patients are added to the program on a rolling basis throughout the year.
The committee contacts the patients and develops the initial care plan that includes a list of the patients' reasons for their past ED visits and the care provided. If the patients sign the release of information, the committee contacts their primary care providers for their input on the ED care plan. If a patient does not have a primary care provider, the case manager finds one for the patient. The case manager always follows up with patients after their first primary care physician visit to determine their comfort level with the physician and ease of access. The case manager also follows up with the physician to discuss any concerns and plans for care.
Patients are categorized into one of more than six tracks based on the most frequent cause of their ED visits, such as general pain, back pain, abdominal pain or behavioral health. There is also a track for elderly patients. The tracks help the hospital team and primary care provider create a care plan that is tailored to each patient's needs. While all patients' care plans include a prohibition of discharge with narcotics, the care plans differ based on specific protocols determined jointly by the primary care provider and program committee.
Coordinating with the primary care provider
A key element of the Consistent Care Program is the hospital's coordination with patients' primary care providers. "It's rooted in the belief that primary care physicians are the key component to a person's ongoing medical care," says Sallie Selfridge, case manager for the program. "[Partnering with primary care physicians] is consistent with Iowa Health System's vision, which is delivering the best outcome for every patient every time."
Agreeing on a standard plan of care for patients creates consistency, which lowers the risk of adverse events and improves efficiency. For example, a primary care physician shared a protocol for a patient with migraines with the program's committee. If the patient came to the ED, she would receive care consistent with care she would receive at the primary care physician's office. "That communication between the primary care physician and hospital is a more holistic approach and provides consistency, which is one of the key parts of our program," says Ms. Selfridge.
Removing barriers to appropriate care
In addition to ensuring patients receive consistent care when presenting to the ED, the Consistent Care Program helps patients remove barriers to seeking care in the most appropriate place, whether the issue is transportation, insurance or lack of awareness of options. As the case manager, Ms. Selfridge helps patients find a primary care physician and arranges for transportation to physician appointments.
Ms. Selfridge also educates patients on healthcare resources available in the community, such as walk-in clinics, and discusses patients' responsibility for their care. For example, she explains patients' need to attend regular wellness checkups, follow medication instructions and make healthy choices. This education helps to empower patients to take charge of their healthcare, according to Ms. Selfridge.
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