Appropriate ER Use May Be Only a Phone Call Away

Thursday, March 8th, 2012
This post was written by Patricia Donovan

Want to reduce avoidable emergency room visits? Pick up the phone, say respondents to our latest Reducing Avoidable ER Visits e-survey — either to respond to callers to your health advice line or to contact patients following an ER visit or hospital stay.

Healthcare organizations who responded to the September 2011 survey report that nurses and doctors are staffing telephonic health advice lines in greater frequency to assess patients before they come to the ER unnecessarily and to educate them about appropriate venues of care. Consider these 2011 survey data:

  • 41 percent of respondents offer nurse-only health advice lines;
  • The use of nurse-only advice lines has jumped 11 percent from 2010 to 2011;
  • 8 percent of respondents offer nurse-physician health advice lines;
  • For 12 percent of respondents, physicians are called in to triage high-acuity calls;
  • Almost 39 percent take time during calls to nurse-only health lines to promote proxy and alternative health services such as an urgent care center, an opportunity second only to contacting patients within 48 hours of the emergency room visit.

The 134 respondents included hospitals, health plans, physicians and other healthcare organizations. A detailed analysis of the 2011 survey provides critical benchmarks that show how the industry is working to reduce avoidable hospital emergency department visits, including data on program components, challenges and benefits and ROI.

Patricia Curtis, RN, BSN, MBA, is director of operations for clinical care services for Optima Health, whose nurse advice line has evolved from a call center supporting a staff model HMO to a critical tool for improving the efficiency of healthcare use. Nurses on the phone work from clinical protocols developed in-house and reviewed by Optima’s physicians.

“We have nurses completing all the assessments. They may or may not ask all of these questions, but [the protocol] gives them a good guide and types of questions they should be asking — for example, things they should be looking for in the triage,” Ms. Curtis explains. “Based on responses to those questions, the [electronic] protocols will lead the nurse to decide what level of care the person needs.

“[Patients] can call any time day or night to ask questions, and there’s always a nurse here to answer those questions,” she continues. All protocols are reviewed at least annually and are available to physicians should they want to see them.

Optima Health was not a survey respondent, but Curtis presented an overview of its nurse advice line during a recent Healthcare Intelligence Network webinar, Maximizing the Nurse Advice Line To Ensure Appropriate Healthcare Utilization.

The second annual survey also found that phone calls out to patients — particularly those recently discharged from the ER or hospital — are making a difference. Key is making these calls within two days of discharge — to confirm that the patient has made a follow-up appointment, that he or she has seen the primary care provider and that there are no questions regarding the care plan provided at discharge.

And finally, more than two-thirds of respondents notify primary care providers when their patients visit the ER, part of an overall trend of engaging physicians in efforts to promote appropriate ER use. (A quarter of respondents say this is the most significant challenge of reducing avoidable ED utilization.)

Physicians successful in these efforts should be rewarded with incentives, said 80 percent of survey respondents, although one respondent feared that if incentives were offered, “providers may keep patients out of the ER even when to admit them would be medically prudent.”

Conversely, two-thirds of survey respondents did not want to see hospitals suffer financial penalties for avoidable visits to their emergency rooms.

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