1. Strategies for Reducing ER Visits and Hospital Readmissions CSI-RI Best Practice Sharing Conference March 18, 2011 Katie McGillicuddy, Quality Assistant Hillside Avenue Family & Community Medicine

2.  Quality Assistant receives all hospital forms then scans and electronically links them to patient’s chart  Linked documents are automatically sent to the doc through the EHR and require the doc’s electronic signature  Less paper on doc’s desk!  Hospital admission notices go to NCM for f/u  ER admissions to QA for f/u Notification/Documentation ER, Observation and Admissions

3.  NCM initial outreach by phone upon discharge  Determines need for office visit follow-up with NCM or MD  Goes over the Four Pillars and patient access to HFCM  Conducts Med Reconciliation as needed and refers complex issues or med list changes to MD  NCM uses note template with reportable fields for all interactions which is sent to the doc via the EMR for electronic co-signature NCM Outreach Admissions

4.  Contacts all patients admitted to the ER  Reminds patients about practice hours and same day visits  Asks about barriers preventing an office visit  Schedules f/u as needed  Documents information in reportable fields using a note template  Performs interventions with frequent ER visitors  Letters  NCM call/visit  Gives NCM cell phone number Quality Assistant Outreach Emergency Room

5.  Quarterly reports capture the following information:  Name of hospital  Visit time  Date and day of the week  Payor  Reason for admission  Patient readmissions  If patient was referred by HFCM or seen for SDA  Confirmation that pt understands medical condition  Knowledge of HFCM hours/SDA policy Reporting Emergency Room

6.  NCM hospital follow-up template Reporting NCM note template with reportable fields

7.  ER follow-up clinical elements table Reporting Emergency Room

8. Reporting Sample E.R. report  ER statistics by time and day of week

9. Quarter 4 (10/1/10-12/31/10)SundayMondayTuesdayWednesdayThursdayFridaySaturdayGrand Total% of Total 12:01AM-8:30AM45575483814.8% 12:01PM-3PM23456693513.6% 3:01PM-5PM644933144316.7% 5:01PM-7PM35765443413.2% 7:01PM-12:00AM910135 7106726.1% Abdominal Pain 1 1 1315.6% Allergic Reaction 11 Back Pain 2 2 Chest Pain1 1 2 Depressive Disorder 1 1 Fever 1 1 Fracture 1 1 Gastroenteritis 1 1 2 Genito-Urinary Problem 11 2 Head Injury 12 3 Headache 1 1 Hypertension 2 1 3 Kidney Stones 1 1 Laceration (w stitches) 1 1 Migraine 1 1 MVA2 2 Myalgia 11 11 4 Other22 1 5 Otitis Media 11 Pneumonia 1 12 Rash11 1 3 Sprain11 1 14 Superficial Injury1 1 1216 Unknown 22 2118 URI 1 12 UTI1 12 Vomiting 11 13 8:31AM-12PM8210637440 Grand Total32294338353149257 Reporting: Results ER statistics detail: reason for visit by time of day

10. Using Data To Drive Improvement Emergency Room  Finding: Largest % of ED visits occur 7P – 12A.  Discussion / Plan  Emphasize more strongly availability of on-call doctor after 7P  Publicize more widely the answering service number  Investigate the possibility of working with a local Urgent Care center to decrease evening ER visits