ED navigators steer patients to appropriate providers
Lower acuity patients referred to PCPs
Since the Presbyterian Healthcare Services in Albuquerque, NM, started its emergency department navigation program, targeting patients who seek treatment for minor ailments, 11,600 patients have been navigated to other levels of care. Only about 5% of them have returned to the emergency department with non-emergent conditions or illnesses.
"Like many other emergency departments, we were seeing an increase in lower acuity patients. In the past, we continued to add beds and fast track systems to accommodate patients with minor illnesses, knowing clearly it wasn't in the best interest of the patients. The healthcare world is changing and we can no longer continue to provide this kind of care at a very high cost," says Mark Stern, MD, MBA, executive medical director of integrated care solutions for Presbyterian Healthcare Services.
Starting with Presbyterian Hospital, the system's flagship facility which experiences 80,000 emergency department visits a year, the health system set up a procedure to screen and evaluate patients with minor illnesses and complaints, and refer them to a primary care provider or urgent care facility for care, when appropriate.
Here's how the program works: All patients who present to the emergency department are assessed by a triage nurse. Those with minor complaints are referred to the hospital's Lean Track area where they are evaluated by a physician or a mid-level provider. If the provider feels that the patient's complaint can be handled safely by a primary care provider within the next 12 to 24 hours, the patient is referred to the emergency department navigator, who can set up an appointment with a primary care provider, or get the patient into an urgent care center.
The navigator makes appointments in real time with a primary care provider or gets them into an urgent care center immediately. If primary care providers are not available within 24 hours, the navigators refer patients to an urgent care center, and schedule a primary care appointment for a more complete evaluation in the future and follow up with patients. The urgent care centers are owned by Presbyterian Healthcare and do not charge patients with no insurance.
"The ultimate goal is to link patients with a primary care provider. We've found that many of these patients don't know how to use the system because nobody sat down and explained it to them. Patients who were in the navigator program were asked why they sought treatment in the emergency department, 93% said they never thought to go anywhere else because their parents and grandparents used the emergency department for primary care," he says.
The navigators explain the benefits of having a relationship with a primary care provider and getting wellness exams. "Many of these patients have insurance, and have a primary care provider assigned to them, but they never thought to call them," Stern says.
The navigators are located at Presbyterian Hospital and are available 24/7. They are not clinicians but are members of the community they serve, who have been chosen for their ability to interact with patients and explain the process to them. They are trained on scheduling and patient complaints. The navigators set patients up with appointments in clinics located near their place of residence, and provide bus tokens to those with transportation problems. The program has been so successful that the hospital's care coordinators use the navigators to set up post-discharge appointments for patients who need a lot of support in making follow-up visits.
Stern points out that an emergency department visit for a minor ailment such as a sore throat costs around $600 while a visit to a primary care physician or urgent care clinic for the same problem costs between $120 and $160. Patients who are treated in the emergency department receive episodic care with no follow up and no continuity in care over time, he points out. In addition studies have shown that patient satisfaction is higher among patients who see a primary care physician or visit an urgent care clinic, he says.
"The goal of the program isn't to improve revenue short-term. The goal is to change long-term behavior. When patients go to the emergency department with a minor complaint, the cost is high and it takes physicians and providers away from real emergencies," he says.
The program has expanded to include Tele-Navigation at two other sites, Presbyterian Kaseman Hospital in Albuquerque and Presbyterian Rust Medical Center, in Rio Rancho, NM. Patients who are appropriate for the navigator program interact with the navigators over a television screen and receive information about their appointments from a fax machine in the room. "Staffing 24/7 at the smaller hospitals is not financially viable. This maximizes the use of the navigators at the main hospital. Patients like the teleconferencing arrangement," Stern says.
Source
For more information, contact:
- Mark Stern, MD, MBA, Executive Medical Director, Integrated Care Solutions for Presbyterian Healthcare Services, Albuquerque, NM. E-mail: [email protected].
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