Case Studies

Emergency Service Partners has the privilege of partnering with top-quality healthcare institutions that are dedicated to excellence within the Emergency Department. These case studies are the result of joint efforts between hospital administration, nursing, staff, and Emergency Service Partners.

Case Study #1
Customer Service

Case Study #2
Customer Service

Case Study #3
Customer Service

Case Study #4
ED High Alert Program

Case Study #5
Virtual ED/Emergency Physician in Triage

In the first three case studies, our collaborative efforts identified three areas that directly relate to customer service within the Emergency Department. These include Left Without Being Seen (LWBS), Turn Around Time (TAT) and Patient Satisfaction Survey Results (Provided by Press Ganey at the three case study hospitals). Case Studies 4 and 5 demonstrate how ESP developed programs to manage unnecessary Emergency Department visits and overcrowding.

ESP Case Study #4: Emergency Department High Alert Program

EMERGENCY DEPARTMENT SETTING:

  • Suburban hospital in large city
  • 27 bed Emergency Department
  • 40,000 annual visits

GOALS:

  • Identify high risk patients:
    • At risk for violence towards staff
    • At risk for self-directed violence (National Patient Safety Goals)
    • At risk for dependent behaviors
  • Reduce unnecessary visits
  • Reduce complaints
  • Reduce conflict between patient and care givers
  • Improve care

PROCESS:

  • Patient identifier within HIS
  • Referrals by nursing staff, physicians and social service
  • Visit review by Medical Director
  • Database input
  • Development of care plan by Medical Director
  • Notification of patient
  • Input from primary care providers
  • Follow through

CRITERIA FOR REVIEW:

  • Greater or equal to 4 visits in one month
  • Greater or equal to 10 visits in one year
  • False alias
  • High risk diagnosis
  • Specific behaviors
  • Failure to follow up as directed
  • Specific concern from care providers

CARE PLANS:

  • Generic plans modified for individual patient
  • Example – migraine
  • Referral to appropriate specialist or medical home
  • Call to PCP, specialist each visit
  • Rescue pain relief only – identify agent
  • No prescription or 1 day supply only

BENEFITS:

  • Superior and more effective alternative to triaging out programs
  • Costs savings – reduce unnecessary visits and diagnostics
  • Improve patient care:
    • Pain specialist referrals
    • PCP referrals
  • Decrease friction between patients and caregivers
  • Improve safety:
    • Staff
    • Patient
    • Visitor
  • Compliance – National Patient Safety Goals (NPSG)
  • Decreased time spent on patient complaints

PHYSICIAN REFERRAL:

  • Physician referral system, high risk diagnosis:
    • Chronic back pain
    • Shoulder pain
    • Dental problems
  • Discharge instructions, referral to case manager for help
  • 2 free passes and out (into High Alert)
  • Patient self-identification

RESOURCES NEEDED:

  • Physician
    • Referrals
    • Visit review
  • Nursing
    • Referrals
    • Buy-in
  • Hospital
    • Patient identifier
    • Database
    • Case manager
    • Discharge instructions
  • Medical Staff
    • Pain management
    • Medical homes

RESULTS:

  • Reduced complaints
  • Increased staff and physician satisfaction
  • Compliant with JCAHO and National Patient Safety Goals
  • Increased patient satisfaction
  • Predictable patient encounters across visits
  • Implementation at all hospitals in system
  • Cost savings in one system of more than $500,000
  • Visit reduction of up to 80% in identified population