ED staff conduct careful research
Visits guide model for redirecting uninsured patients
The ED at Metro Health Medical Center in Cleveland began considering a new policy for patients with minor ailments about two years ago, recalls Charles L. Emerman, MD, chairman of the Department of Emergency Medicine. "Our ED was designed for 100,000 patients a year, and it had become apparent we were going to hit that fairly quickly," he explains.
The ED's leaders embarked on an exhaustive research initiative. "We put together a team that looked at the medical research, and I spoke with people I knew [in EDs] in Sacramento, Milwaukee, and Denver," recalls Emerman. In addition, Karen Smith, RN, MSN, the ED's director of nursing, and an administrator went to several hospitals in Texas to see how they had approached the problem.
While the basic model ultimately adopted by MetroHealth is similar to many found in other EDs, there are some distinct differences. For one thing, notes Smith, MetroHealth's point-of-service fee of $75 for noninsured patients is below the average Smith found in other facilities. "We were conservative," she notes.
In addition, while the facilities in Texas have midlevel providers in triage, MetroHealth only uses RNs. "It made sense for patient flow, since the patients would ultimately be seen by RNs anyway," notes Emerman. "This allows them to make their assessments earlier, and our legal people advised us that CMS [the Centers for Medicare & Medicaid Services] allows trained nurses under protocol to do medical assessments."
All of these nurses, adds Smith, are "triage advance ED assessment nurses," who have been through special training. This is an important issue for other EDs considering a similar model, notes Emerman. "Any ED could do this, depending on the training of the nurses, and the prevailing practice act in their state," he explains.
Offering patients the option to be seen elsewhere is also a unique feature of the MetroHealth approach, says Smith. "In Texas, if the patient's condition is not an emergency, they are basically told 'there's the door'; whereas, we offer them the option to be seen in a neighborhood clinic," Smith says.
The ED at Metro Health Medical Center in Cleveland began considering a new policy for patients with minor ailments about two years ago, recalls Charles L.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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