Kaiser Foundation Health Plan of Colorado uses a number of strategies to find out why individuals use the ED, explains Sara Tracy, senior manager of emergency services for Kaiser.
There is a fair amount of literature that talks about why people use the ED --- people truly think that they have an emergency, an individual may not have access to primary care or they can not get in a timely manner, they may not have received a phone call back if they had called in to see what to do about their condition, primary care wasn’t open when they needed it or they couldn’t access it. Then some individuals may say, “I didn’t know my care options.” Many of our members said they don’t realize that they have other options outside of the ER. We also have our resource-intensive members who use the ED excessively.
In one of our core facilities, we conducted a post-discharge survey of our ED patients to understand why they went to the ED. Part of the survey was a satisfaction survey to understand the patient’s satisfaction with the service that we had provided, and the second half asked them why they went to the ED. The survey found that 46 percent of them stated that they would have gone to their primary care office instead of the ED if they could have. Of that 46 percent, 81 percent cited the office being closed as the reason why they didn’t go. We’re currently delving further into this particular subset of patients to identify the time of day and the day of the week that patients cited the office as being closed, to understand if this is an education component or if it’s truly 2:00 AM and the member has no other options but the ED.
Additionally, we manage a nurse advice service for our members that’s 24 hours a day, seven days a week. We send out written surveys to our members who use the after-hour service to determine the satisfaction with the service and the outcomes. Because we have an inbound and outbound model, we found that if we don’t call them back within 60 minutes, those members were more likely to go to the ED. They wanted an answer about their condition and they wanted it quickly.
Our strategies to get members to the appropriate care include understanding how, why and when they’re accessing ED care. We wanted to know how often they are calling Kaiser Permanente medical offices and their physicians before they go to the ED. We found that approximately 45 percent of our members called us before they went in to either try to seek advice, to get an appointment or to understand where to go. As we address those members who call us, we are working on scripting with our medical office staff that includes where to send the members as well as what their alternate care options are. Our goal is to move further upstream to intercede and redirect that member prior to the ED visit, which is what we call “pre-patriation” --- to attempt to get the member to the correct venue for their care the first time.