<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%>Continuing Ed Chronicle Jan 2006

EMERGENCY ROOM CASE MANAGEMENT
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EMERGENCY ROOM CASE MANAGEMENT

Table of Contents

A. Models of Emergency Room Management
B. Social Work in the Emergency Room
C. Utilization Review in the ER
D. Overuse/Overcrowding Issues and Risk Management
E. Managed Care in the ER
F. Disease Management
G. Outcomes Management in the ER

A. MODELS of EMERGENCY ROOM
MANAGEMENT

A successful emergency department case management practice model.

A New Model of Health Care Leads to Lower Cost and Better Quality of Care
“a case management paradigm is a “win-win” situation for both patients and health care providers in that case management provides continuity of care for patients, greater compliance, less reliance on Emergency Department services and is an overall cost effective way to treat patients with a chronic health condition like epilepsy.”

Emergency Department Geriatric Case Manager links seniors to the appropriate services

An experimental comparison of three types of case management for homeless mentally ill persons.

A multidisciplinary Care Coordination Team improves emergency department discharge planning practice.
Target population:

  • Frail elderly
  • Those living alone
  • The homeless
  • Those with history of frequent ER department visits
  • Those with complex medical or drug/alcohol problems.

A multidisciplinary Care Coordination Team (CCT) was formed at the end of July 2000 to ensure that emergency department patients were provided with services that would facilitate their return to, or maintenance in, the community.”

Clinical case management reduced ER utilization and homelessness among high users of the medical emergency room: Initial results of a randomized trial.

The Domain Management Model—A Tool for Teaching and Management of Older Adults in Emergency Departments.

“This model can educate health care staff, facilitate team care, improve flow of relevant information, improve decision making, and facilitate more meaningful interactions with patients.”

Emergency Department Case Management: The Dyad Team of Nurse Case Manager and Social Worker Improve Discharge Planning and Patient and Staff Satisfaction While Decreasing Inappropriate Admissions and Costs: A Literature Review. “The individual and combined roles of the dyad team of social worker and nurse case manager are discussed”.


B. SOCIAL WORK
in the EMERGENCY ROOM

Case Studies - Domestic Violence

Effects of social work intervention on nonemergent pediatric emergency department utilization

Social Work Best Practice – Healthcare Case Management Standards

Social Work and Discharge Planning

A little
Humor
On Duty in the Emergency Room: The Untold Story of a Fried Social Worker

Utilization Review in the ER2
UTILIZATION REVIEW
in the ER

CEU Article #1
  Utilization and Overcrowding of Hospital Emergency Departments
“Overcrowding within the ED is associated with poorer outcomes of care and can result in prolonged discomfort and pain for patients.” “Over-utilization is a concern because of cost…patients are often given an extensive set of diagnostic tests that might otherwise be unnecessary if clinicians were more familiar with patients and their records”.

Reduce Emergency Room Utilization – October 2005

ER Utilization Intervention

Clinical case management reduces ER utilization and homelessness among high users of the medical ER. “This study evaluated the effectiveness of a comprehensive clinical case management program, designed to reduce ER utilization and improve functioning and quality of life by providing supportive therapy, crisis intervention, and linkage to health, social and substance abuse services”

Emergency Department Utilization and Surge Capacity in New Jersey, 1998-2003



REVIEW PAST ISSUES


NEWSLETTER ARCHIVES
BOOKS on EMERGENCY ROOM
NURSING & CASE MANAGEMENT

D. Overuse/Overcrowding Issues
and Risk Management

Frequent users of the emergency department: a program to improve care and reduce visits

Reducing emergency department visits among high-using patients – Journal of Family Practice, August 2003

What is the role of primary care in emergency department overcrowding?
“The use of the ED for nonurgent care and primary care treatable conditions provides an important lens through which to examine needed changes in the health care delivery system”.

Emergency Room Case Management

CEU Article #2
  Bursting at the Seams: Improving Patient Flow to Help America’s Emergency Departments
“The number of ED visits increased by 23% from 1992-2002, while the number of EDs decreased 15% during the same time period, according to the CDC.” In an eral when hospitals nationwide are being forced to do more with less, finding strategies to improve patient flow has become more critical than ever”.

Improvement Report: Eliminate Overcrowding in the Emergency Department

A Brief Risk-stratification Tool to Predict Repeat Emergency Department Visits and Hospitalizations in Older Patients Discharged from the Emergency Department
“Older ED patients with two or more risk factors on a simple triage screening tool were found to be at significantly increased risk for subsequent ED use, hospitalization, and nursing home admission.”

E. MANAGED CARE in the ER

Managed Care, Utilization Management, and Case Management in the Emergency Department
“The ED environment can no longer support being all things to all persons. We must demonstrate the delivery of patient-focused care while being willing to pursue and advocate all effective health care delivery options. In this
new environment, multiple paradigms are truly becoming the norm.”

Approaches to Addressing the Realities of Emergency Department Use In Medicaid Managed Care

The association between care co-ordination and emergency department use in older managed care enrollees
“Existing measures of care co-ordination were not associated with inappropriate ED use in this study of older adults with complex care needs. The absence of an association may, in part, be attributable to the paucity of validated measures to assess care co-ordination, as well as the methodological complexity inherent in studying this topic.”

F. DISEASE MANAGEMENT

Predicting High Utilization of Emergency Department Services Among Patients with a Diagnosis of Psychosis in a Medicaid Managed Care Organization
“This study sought to develop a predictive model of emergency department (ED) utilization for patients where a diagnosis of psychosis could be identified from a claim associated with a medical service provider visit. Four variables were significant predictors of high ED utilization: prior number of ED visits, prior number of hospitalizations, history of alcohol abuse, and history of depression”.

Addressing the Realities of Emergency Department Use in Medicaid Managed Care

G. OUTCOMES MANAGEMENT
in the ER

Emergency departments (EDs) are the leading providers of fragmented and uncontrolled costly healthcare ( Bristow & Herrick, 2002 ). Many patients come to the ED because they do not have a physician and have no other mechanism for accessing healthcare. This makes EDs the leading providers of unscheduled primary and acute care. ED is part of the growing safety net for the medically indigent in the United States and an important source of health care for the uninsured or underinsured.

A Prediction Rule for Serious Outcomes of Syncope in Emergency Room Patients May Reduce Admissions
“A clinical prediction rule that identifies historical elements or test findings with the greatest predictive value can help in the development of standardized workups that are efficient and minimize the risk of missing a diagnosis.”


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