Improve Clinical Communication to Reduce ED Overuse and Control Costs

Brad Brooks is Co-Founder & Chief Executive Officer of TigerTextBy Brad Brooks

Much has been written recently about the opioid epidemic running rampantly through American cities and towns. The crisis impacts everyone, including hospitals that are being inundated by patients with opioid-related emergencies, often including overdoses of potentially lethal combinations of prescription medications and illegal drugs. 

Concurrently, healthcare organizations are seeing an increase in patients visiting emergency departments (EDs) complaining of pain in order to obtain opioid prescriptions. Drug-seeking patients typically return to the ED several times a year, or visit multiple hospitals in surrounding communities in search of having a prescription filled.

ED overuse, however, is not exclusive to drug addicted patients. It also includes patients with mental illness; with multiple, uncontrolled chronic diseases; or those who believe the ED is their only access to care.

The financial consequences of unnecessary ED utilization are very real. One study estimates that $38 billion in spending each year could be eliminated by diverting care from the ED to a more appropriate setting. Streamlined clinical communication can help hospitals and health systems to reduce some of this overuse, improve patient care through more appropriate actions, and augment reimbursement under value-based payment models through better efficacy.

By aligning communications across multi-disciplinary care teams—not just physicians and nurses—but also social workers and rehabilitation facilities, patients can get the effective, appropriate help they need and organizations can reduce wasteful care spending.



Changing ED triage strategies

One of the keys to appropriate care treatment is to use data analytics to identify frequent ED utilizers and establish treatment process flows. One organization that has successfully confronted this challenge is Kennedy Health, a three-hospital, 607-bed integrated healthcare delivery system providing a full continuum of healthcare in southwest New Jersey.

In 2013, Kennedy Health discovered through analysis that in one six-month period, just 21 patients accounted for an astounding 903 visits to its emergency departments. With this realization, the organization began an initiative to reduce the number of repeat ED visits and readmissions among this population of patients.

Unsurprisingly, Kennedy Health found that many patients were repeatedly visiting ED seeking opioid prescriptions. In many cases, these patients may have already received expensive diagnostic imaging tests or been admitted to the hospital. Not only does this wasted care increase costs, it leads to care delays for other patients that can negatively influence outcomes and the patient experience.

Due to the fast pace and unpredictable environment of most EDs, team communication concerning a single patient is highly challenging. That is where a unified, mobile clinical communication platform helps prevent an unnecessary admission and routes the patient to an appropriate care setting, enabling the organization and the payer to lower costs while improving patient outcomes.

Driving efficient clinical workflows through communication

Kennedy, as well as most other hospitals, utilize an electronic health record (EHR) system. However, while EHRs are tremendous data resources, they are typically unaligned with clinical workflows. Physicians and nurses can’t access both the EHR and efficient communication tools they need at the point of care to drive safer, more cost-effective decisions.

In EDs, this problem is exacerbated with clinicians being pulled in numerous different directions to treat a high volume of patients. Few have time to log-in to the EHR to identify these ED utilization patterns and frequent visitors in real time. That alert should instead be delivered to them on an integrated, mobile clinical communication platform to initiate the drug-seeking intervention process.

Once the ED frequent visitor is identified, the triage nurse can create a secure, group text message that includes the attending physician, social worker, a rehabilitation facility representative, the patient’s primary care physician or other relevant clinicians. Collaborating on the platform, the care team can decide on the most effective treatment course for the patient. They then can add other hospital services to the text message group, such as transportation, to help the patient immediately access the appropriate care setting.

Safely reducing ED utilization

A similar ED triage and diversion process was implemented at Kennedy Health across all three of its campuses. The number of visits among these ED overuse patients decreased 73 percent, while reducing the utilization of CT scans and certain medications, all of which reduced costs and provided more effective care. The organization was also able to consolidate its case management staff, helping them work more efficiently on the communication platform from a single hospital location.

Reducing ED utilization, however, is not only a cost-cutting issue. These types of initiatives are focused on helping patients access the right type of care—for both their physical and mental health. In situations with drug-seeking behaviors, that means using efficient clinical communications to align patients with the necessary services to keep them out of the ED and on a path to recovery. This is a win for the health system, the payer and most importantly the patients seeking care.

About the author:

Brad Brooks is Co-Founder & Chief Executive Officer of TigerText.

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