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We are also in the process of restructuring to address this very issue. We’ve decided to establish a Triad leadership model to oversee all Community Based Care for our integrated healthcare system. The triad consists of a COO, CNO, and CMO. Under the leadership of this triad, we’ve placed our medical group, homecare, palliative care, the ACO, senior services, SNF relationships, and our wellness and health promotion strategy. It’s clear organizationally that this group has responsibility for delivering on our population health goals and they will direct all post-acute care activities and will be the decision makers on tools and platforms needed to support care.

This is a very complex problem and will require a multifaceted solution which include the suggestions above.
1. Our system established an urgent care network a number of years ago, including a few “Kids Care” clinics.
2. We’ve experimented with the hours of service, extending hours up until Midnight in areas where we had high volumes of ED patients.
3. We initiated a nurse triage line for the patients we assume risk for-the nurse triage line sends about 4% of callers to the ED, 35% get a PCP appointment within 24 hours, 15% are referred to our tele-health service, a high percentage are able to have their concern managed by the nurse.
4. We initiated a post-ED follow up phone call within 48 hours of their visit, those who accept the call have a significantly lower return ED visit within 5 days.
5. We’ve established a fast track process for the non-urgent patients in the ED
6. We’ve placed a significant effort on opening access and increasing the number of same day clinic appointments available in our Primary Care clinics. Our ED care managers have access to the primary care schedules and can get patients transitioned out to the PCP if appropriate.
7. Lastly, we’ve opened Behavioral Health Access Centers next to our largest Emergency Departments. Patients can present to the ED and be triaged to the Behavioral Health Access Center or present directly to the Access center for admission. The access centers are staffed with Mental Health APRN’s, RN’s and Behavioral health techs. They are able to assess and manage patients for up to 24 hours. This is reducing the burden of mental health patients in our ED’s who are awaiting disposition. Many do not need to be admitted because they’re crisis is managed and they can be set up for outpatient follow up.

With these efforts, less than 40% of our ED visits are for non-urgent/emergent care. These efforts have increased our % of high acuity patients and has made it difficult for benchmarking staffing levels but is supporting patients being cared for in the most appropriate setting.