Emergency Department (ED), which is designed to handle 90,000 cases, sees more than 118,000 patients annually. These numbers, which can lead to longer wait times in the ED, can adversely impact the patient experience and employee satisfaction. Penn Medicine Lancaster General Health Physicians’ academic practices turned an idea into an initiative that provides education and resources to help ensure that patients are using the ED appropriately.
In the last fiscal year, more than 5,200 patients sought care at the ED for a condition that could have been treated by their primary-care practice or at an urgent-care center.
Regional medical director Christian Hermansen, MD, MBA, family medicine resident Kevin Lynch, MD, research intern Tawnya Vernon, and clinical manager for Family Medicine Downtown Pam Harnish collected and reviewed data by contacting patients to identify why they elected to visit the ED instead of a primary- or urgent-care practice.
The team, which also included leadership representation from the practice locations, discovered that approximately 15 percent of patients who visited the ED had conditions that could have been properly cared for in a primary- or urgent-care practice. The reasons for choosing the ED differed by patient — some chose the ED due to convenience, some Medicaid patients chose the ED to avoid a co-pay, and some, while not needing emergent-level care, simply perceived it as an emergency.
“As part of the organization-wide goal, we wanted to reduce low-acuity attendance in the ED by four percent,” Hermansen said. Low-acuity, he explained, describes those cases that are less severe and not considered an emergency.
The first step included ensuring that staff members were aware of best practices and the goal to educate patients on all care options available to them. These options include scheduling an appointment with their primary-care provider, using MyLGHealth to communicate concerns, or visiting an urgent care center.
“Internally we used our huddles as a place to engage all staff in the process. Through our huddles, we worked to provide staff with the appropriate resources to help them facilitate conversations with patients,” said Harnish.
The second step became educating patients on the services their primary care practice or an urgent care center could provide. In addition to utilizing the Duke Street Urgent Care, which opened in March 2017, and extending lunch and evening office hours at Family Medicine Downtown, the team knew that consistent messaging and tools could continue to reduce unnecessary ED visits by their practices’ patients.
“We constantly re-educate our patients on the options they have for care,” Hermansen said. “We partner with them in ways that value the patient-provider relationship and enable us to be good stewards of health-care dollars.”
At the end of the fiscal year, the LGHP locations participating in the research experienced a 23 percent decrease in ED visits for lower-acuity cases that can properly be treated at an urgent care or primary-care practice.
“We acknowledge that there is a large opportunity to continue to grow this initiative among other primary care offices, while introducing other small changes based on the needs of the populations served. Overall, we look forward to expanding this project and hope to continue to see it positively impact the ED pressure in the future,”Hermansen said.