Throughout the United States, patients are using the ED for the treatment of acute but minor episodic conditions. According to Truven Health Analytics, 42% of ED visits are for urgencies that could be treated in the primary care office setting. Even as more urgent care centers are being opened, this problem persists. In some cases, ED care is sought because a patient’s primary care physician (PCP) office operates mostly within normal daytime business hours. Other times, it may be because of difficulty in obtaining same day appointments. There are simple changes PCPs can make to help patients avoid ending up in the ED for these types of conditions.

The Greater Detroit Area Health Council (GDAHC) ED Utilization Team leads the effort in Detroit. In my work as chair of the GDAHC team—which includes representation from EDs, PCPs, purchasers, health plans and consumers—we piloted an initiative with 11 PCPs at five practice sites to give patients better options when faced with acute, unscheduled medical needs. Sites were chosen because they had a worsening trend of their HMO members using the ED for conditions likely treatable in the PCP office. Collectively, these PCPs reduced these types of ED visits from 49.2 to 7.3 visits per 1,000 members. Here are some of the key lessons from our program:

Collaborate

The goal is to get everyone in the PCP office working together in the same direction. The first step is to establish an access-to-care policy. Everyone from receptionists to nurses to physicians needs to understand what access to care means and define it together. This includes how to handle clinical advice for patients over the phone and what to do if patients need appointments that day. Everyone needs to be on the same page.

PrimaryCare-Avoidable-ED-Callout

Keep it Simple

Simplicity is one of our pilot’s biggest assets. We developed a toolkit to help practices adopt easy-to-implement interventions. These include a suggested after-hours telephone recording that directs patients to the appropriate care provider and informational talking points for medical assistants to use when taking patients to an exam room. Following the pilot, we created a poster and brochure that offer simple guidelines on how to choose where to go for unscheduled care.

Partners & Champions

Physician organizations and accountable care organizations can be influential in initiating and sustaining change by learning the culture within their partner PCP offices so champions can be identified for any needed improvement efforts. By collaborating with stakeholders to engage physician practices and help them focus their attention, these organizations can be a force of change within the community.

References

Goodman, RM. Emergency department use associated with primary care office management. Am J Manag Care. 2013;19:e185-e196. Available at: http://www.ajmc.com/publications/issue/2013/2013-1-vol19-n5/Emergency-Department-Use-Associated-With-Primary-Care-Office-Management.

Avoidable emergency department usage analysis. Truven Health Analytics. Ann Arbor, MI. 2013. Available at: img.en25.com/Web/TruvenHealthAnalytics/EMP_12260_0113_AvoidableERAdmissionsRB_WEB_2868.pdf.

Reducing inappropriate emergency department use requires coordination with primary care. Robert Wood Johnson Foundation. Princeton, NJ. 2013. Available at: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407773.

Low-tech solutions for the high-cost problem of emergency department overuse. Robert Wood Johnson Foundation. Princeton, NJ. 2013. Available at: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407781.