By Stacey Kusterbeck
As a resident at a family medicine clinic, Rock P. Vomer II, DO, grew concerned that the same patients repeatedly ended up in the emergency department (ED), but not because of emergencies. Many patients with diabetes or COPD routinely visited the ED just because they needed a prescription refill, or because they had taken medication incorrectly, or for other minor issues that could have been managed by primary care.
The ED providers had given the patients discharge instructions to follow up on an outpatient basis. However, the patients never showed up for those appointments and kept visiting the ED instead.
Vomer was in the habit of calling some patients to check on them and had the idea of doing so in a more formal way to eliminate the underlying reason for the ED visits. Vomer and colleagues conducted a quality improvement project to get frequent ED visitors the care they needed and keep them out of the ED.1 The researchers identified the 50 top super-utilizing patients at Sentara Norfolk (VA) General Hospital’s ED in 2020 and contacted them about enrolling in a chronic care management program. All the patients had four or more ED visits in the three-month review period. Most of the super-utilizing patients either could not be reached or were not interested in participating. Only seven of the patients agreed to be enrolled. Those patients received three monthly phone or video calls from one of four participating residents. During the calls, the resident discussed the patient’s medical conditions and health concerns, any barriers to care the patient encountered, and connected the patient with community resources. Residents also encouraged the patients to contact the clinic before going to the ED to see if their issue could be resolved.
The team compared the number of avoidable ED visits before and after the intervention and found that it decreased by 70%. “Some of these patients were going to the ED a few times a month, and then just stopped going. The problem that was causing them to go was eliminated because of a simple five- or 10-minute call,” Vomer reports.
The participating patients expressed gratitude for the residents taking an interest in their well-being. “They had a good experience and a good outcome, and it saved time and money. Everybody won,” Vomer says.
In Vomer’s view, eliminating avoidable ED visits was possible specifically because someone tried to establish a relationship with the super-utilizing patients. “If you take the time to go to the patient and say you want to have a relationship, the patient sees that you care about them,” he says.
To participate in the program, patients needed to be willing and able to take part in a scheduled monthly call. For frequent ED patients who currently are homeless and/or cannot be reached via cellphone, a different approach would be needed, Vomer acknowledges. Additionally, although there was a sharp decrease in ED visits for the seven patients, the data are difficult to interpret due to the very small sample size. Thus, it is unlikely to get buy-in from hospital leadership to invest in a similar program in their EDs. Data are needed showing that the intervention works on a larger scale.
Regardless, the findings show that at least some super-utilizers can be kept out of the ED with a simple monthly call. “If we are going to start making change in healthcare, you’ve got to start somewhere. If you can help even just a few ED super-users, it frees up resources for other patients,” Vomer says.
REFERENCE
- Vomer RP 2nd, York E, Greer J, et al. Using chronic care management visits to reduce the number of frequent emergency department visits: A pilot study. Cureus 2023;15:e48053.
Researchers at a Virginia hospital conducted a quality improvement project to get frequent ED visitors the care they needed and keep them out of the ED. The researchers identified the 50 top super-utilizing patients at Sentara Norfolk (VA) General Hospital’s ED in 2020 and contacted them about enrolling in a chronic care management program.
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