Healthcare News & Insights

Cutting ED use: One hospital’s success story

It can be tough for hospitals to control unnecessary emergency department use, particularly with disadvantaged or underinsured patients. But one hospital is trying a different approach to decrease the chances these patients will visit the ED for minor illnesses. 

senior-patient-and-doctorAn article on NPR describes the new initiative at Aurora Sinai Medical Center, a facility in Milwaukee that primarily sees poor patients.

The hospital goes beyond steering these patients away from the ED, attempting to help them establish relationships with local primary care doctors and other providers instead.

Personalized strategy

To start, the hospital identified over 300 of its “superutilizers,” or patients who visited the ED at least five times over four months. Many of these patients were newly insured under the Medicaid expansion due to the Affordable Care Act. In total, they made 1,827 visits to the ED during the four-month study period.

Then, Aurora Sinai staffed its ED with several full-time social workers. The employees chose 39 of the superutilizers to follow over eight months, working to steer them toward visiting a doctor or clinic when they felt sick – rather than immediately visiting the ED.

Social workers created individualized plans for patients to make it easier for them to see a primary care provider. The plans covered everything from transporting them to appointments to making child-care arrangements.

The social workers helped patients find doctors. Occasionally, they’d even accompany the patient to the first appointment. After the initial appointment, social workers assisted patients with making at least two follow-up visits to their new providers.

Their efforts paid off. The rates of ED visits for these patients fell by 68%. And this decrease came with a $1 million savings for the hospital. So although the hospital spent money from its budget for this initiative, it seems to be reaping the benefits already.

Plus, the article notes, there’s the potential for even more savings down the line if the patients continue to see their new doctors.

Future goals

Aurora Sinai plans to expand on its approach by opening a community health center and urgent care clinic onsite. That way, hospital staff can direct even more patients away from the ED to a more appropriate setting for their care.

The hospital will also include the remaining superutilizers in its program, connecting them with social workers to help them address their psychosocial needs before scheduling appointments with new doctors.

Building relationships

While not all hospitals have the resources to hire social workers or build an onsite clinic, facilities can still reach out to community organizations that can provide resources to disadvantaged patients, such as local nonprofits. Building connections can make it easier to refer patients to programs to help improve their quality of life.

It’s also helpful to establish relationships with local primary care providers for follow-up care after discharge so you can provide information about their practices to patients who may not have a regular doctor.

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