A Chance for PCPs to Intervene in the ED
At 8:24 a.m. on Thursday, June 22nd 2017, the average emergency department wait time at Massachusetts General Hospital in Boston, Massachusetts was nine minutes. We know that not because we visited the ED that day, but because we visited their Yelp listing.
If you’ve spent anytime in healthcare, you know that reducing ED wait times is a priority. However, the time from door to room is not the only wait time that matters in emergency care. The entire emergency department experience (from waiting room to discharge) can take between four to five hours in some states, and even longer if they are transferred to another facility or to a hospital bed. Bottlenecks existing in emergency department processes illuminate opportunities for better care coordination among providers to get patients out of the emergency department and on to either a post-acute facility or back home.
By nature, emergency departments face unexpected and unplanned visits leading to inefficient patient flow. And with increasing patient volume, EDs tend to be overcrowded, making it tough to piece together a patient’s healthcare journey and make personalized decisions for everyone that walks through the door.
Once a patient is seen, emergency physicians (EPs) must review mountains of EHR data, trying to determine which information is critical and relevant for the patient. In some cases, EPs conduct their own patient review and analysis. During an assessment, for example, clinicians may order redundant tests or prescribe medications that conflict with current medications, simply because they are unable locate current information on the patient. And, in the event that a patient needs a transfer or referral, emergency teams are likely to use their own resources and networks to make a connection. This approach is expensive, slow, and at times ineffective.
With the extra testing, data sorting, and other processes, it can take emergency staff hours to to ‘solve’ the patient’s case and decide to either admit them to the hospital, send them home, or send them to another healthcare facility.
Though delays are not usually celebrated, particularly in healthcare, these wait times may have a silver lining. A waiting period gives a rare opportunity for primary care physicians (PCPs) to intervene in the process of care. Consider for a minute: If you are a PCP and have a patient that presents to the ED, what could you do in the next four hours to help inform their treatment options, shape their care plan, and ultimately improve their experience and outcome?
Collaboration between PCPs and emergency physicians (EP) is critical to success in the emergency experience. A study of PCPs and EPs published by the National Institute for Health Care Reform found that poor coordination and poor communication between PCPs and EPs were the biggest contributors to inefficiency in patient care.
Although CMS incentive programs have made PCP-EP collaboration a priority, the current model still depends on the emergency team reaching out during the emergency experience. And, with EPs being pulled in many directions, there’s no guaranteeing when in the process it will happen.
Instead, PCPs can take a proactive approach. Intervention can reduce or eliminate duplicate work, conflicting plans, and ultimately lead to the best treatment for the patient.
EP-PCP Partnerships in Action
In Chicago, Esperanza Health Centers, a federally qualified health center, helped a non-network hospital with the treatment of a newborn who frequently visited the ER for asthma attacks. Around the time the baby’s visits began, the ACO that EHC is a part of launched a care coordination program to alert the system, including members of Esperanza Health Centers, when its patients visited the ER. Through this new approach, they were able to intervene at every visit, stop the baby’s hospital visits, and ultimately help eliminate the asthma attacks altogether.
With the shift to value-based care, and an increasing responsibility placed on PCPs and ACOs, care coordination between emergency physicians and primary care providers is the key to more efficient and effective care.
With the ED process taking four-plus hours on average, PCPs have an opportunity to intervene in the emergency experience and work with hospital staff to collaboratively determine the best course of action for each patient.