Emergency departments (EDs) offer unique opportunities to engage Medicaid patients. The Emergency Department Triage for At-risk Patients project targets Medicaid patients who use the ED for preventable or avoidable complaints, and those that could have been more appropriately treated in a primary care setting. The project is also known as the Emergency Department Triage Project or ED Triage.
The goal of the ED Triage project is to connect these patients to primary care to prevent future avoidable ED visits. Project staff schedule primary care appointments for patients, identifies and address barriers that may affect patients’ abilities to make it to the primary care appointments, provide reminder calls to the patients prior to the appointment, and follow up with the provider to confirm that the patient made it to the appointment.
The barriers to care brief assessment, which is completed with each patient served, identifies if a patient has a primary care provider, is able to get to appointments (mobility and transportation), has problems getting their medications and understands their purpose, and if the patient understands any medical conditions they may have. When indicated, staff help patients select a new primary care provider and make this change with the managed care company, arrange transportation, and inform patients about services available from many local pharmacies to have medications delivered or ways to reduce their out of pocket costs. Patients who do not understand their conditions or medications are coached so that they are empowered to talk to their doctor or pharmacist.
While most patients need a primary care appointment following an ED visit, some need to follow up with another type of provider. For example, patients who seek care in the ED for a dental complaint are referred to a dentist. Others need follow up with specialty care before a primary care appointment may be needed. The ED Triage staff will make these appointments for patients whenever possible. There are also some patients who need more assistance and support, particularly those patients who have high ED utilization. Staff may meet patients at their primary care appointment if they have a history of missed appointments, they can facilitate communication among providers, and may be called in to assist patients with needs beyond just scheduling a primary care appointment.
The ED Triage Project is up and running at two EDs in the Millennium network, Erie County Medical Center (ECMC) and Niagara Falls Memorial Medical Center (NFMMC). The process was developed and tested at ECMC starting in April 2015 and full implementation began July 1. NFMMC hired their ED Triage staff in mid-July and started implementing the project by the end of the month. Since the launch, over 600 patients have been served by the project. Work with Olean General begins this month with implementation anticipated to begin by the end of the quarter.
Patient response to this new service is overwhelmingly positive. Many patients have never had a primary care doctor or have not seen them in years. For many, the ED has been their sole point of access to the health care system. The ED providers are also very positive – through this project they are learning that frequent or “inappropriate” ED utilization is not necessarily an indicator that a patient wants to misuse the healthcare system or clog the ED with non-emergency complaints, but is often related to a lack of access or resources to address their health issues in more effective, lower cost ways. Many patients use the ED because they don’t know how to use primary care, can’t get access, or do not feel confident seeking care in an unfamiliar setting. The ED Triage staff helps patients with those needs and issues that the healthcare system previously did not have time to address; yet addressing those needs is the critical piece for changing how patients use health care services and to move towards better health.
Each hospital and their patient population in the Millennium network are unique. This project was designed to allow participating hospitals to implement the project in a manner that best suits them, taking into account other internal and external resources, existing processes, and the needs of the patients.
The success of this project depends on strong partnerships among the ED Triage staff, ED personnel, primary care, other providers, managed care companies and community-based services including health homes. Through the efforts of the ED Triage Project, and all of the MCC projects, opportunities to transform the healthcare service system will be identified and leveraged. Transformation will require changing how patients access care and how care is delivered. ED Triage will engage both patients and providers in moving our community towards making better decisions about where to seek care and make the system easier for patient’s to navigate.
Amy Rockwood is the project manager for the Emergency Department Triage Project. For more information, you can contact her via email at firstname.lastname@example.org.