5/24/2015
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Fitting the Pieces Together
Utilizing a Hospitalist in the ED to
Reduce Admissions
Presented by:
Patty Williamson, CFO
Isidoros Vardaros, M.D.
5/24/2015
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Quincy Medical Group
•Multi-specialty medical group serving Quincy, IL andsurrounding tri-state area
•100 Physicians, 135 Total Providers
•All primary care physicians are Level 3 NCQA PCMHcertified
•Blessing Hospital is independent and is not part ofthe UnityPoint system
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Strategy = Triple Aim
•QMG’s strategic plan is the Triple Aim
•Focused on developing change agents within theorganization
•3 physician led committees
–Quality – 5 physician led teams around diabetes,hypertension, COPD, osteoporosis, and CHF
–Patient Satisfaction – providing transparent Press Ganeyresults with a goal of achieving the 90th percentile
–Total Cost of Care – focused on reducing hospitaladmissions
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10 Initiatives
1.After Hours Nurse Triage Phone Service via UnityPoint
2.Home Health Care via UnityPoint at Home
3.Expand ACC and/or Primary Care hours
4.Expand Infusion Center and Imaging hours
5.Hospitalist assessing patient in Emergency Room
6.Use Nurse Care Coordinator Model – BCBS Int. MedicalHome
7.Discharge Nurses to ensure good transition to outpatient
8.Nursing Home NP model of care
9.Patient education about preferred access points
10.Educate physicians on preferred ER referral process
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Logistics of the Practice
Located in the ER:
•Direct access to patient care before finaladmission or discharge is determined by ERphysician
•Compare labs/notes from QMG’s record andhospital’s record to assess patient’s change inmedical status
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Logistics of the Practice
Service for QMG Patients:
•Exclusively for QMG patients
•Direct patient toward the correct admittingphysician or discharge to the primary careprovider
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Logistics of the Practice
Ages Served:
•Discharge patients as young as 6 months oldwith appropriate follow up
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Logistics of the Practice
Identifying Patients:
•Blessing Hospital provides QMG census report
•Able to view QMG patients that are currentlyin the ED under “ED Status”
•Directly assess patients once the ER physicianhas completed their initial encounter
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U-Turn to Appropriate Care
Assess Patients with Status of:
•Inpatient Admission
•Observation Admission
•30 Day Re-admission
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U-Turn to Appropriate Care
•Observation Status: Does not meet inpatientcriteria
•30 Day Re-admission: Returns to ED less than30 days from previous discharge
•Goal is to treat “observation” or “30 day re-admission” patients in the outpatient settingwhen appropriate
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Improving Patient Care by…
Educating Patients on Preferred Access Points:
•Scheduling appointments with specialists ifwarranted
•Ordering future lab studies or investigativeprocedure as an outpatient
•Scheduling PT / OT / Rehab / Home Health Carewhen appropriate
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Improving Patient Care by…
Redirecting Patients to Primary Care:
•Scheduling “same day” or “next day”appointments with PCP or specialist
•Leaving available time slots for futureappointments
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Improving Patient Care by…
Scheduling Next Day Appointments:
•QMG schedule hotline
•Available during regular office hours toschedule appointments
•Available on-call during hospitalist work hours
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Improving Patient Care by…
Care Coordination with Primary Care Physician:
•Work closely with ED physician and relate anycurrent outpatient labs / investigativeprocedures
•Document “ED encounter” in hospital’s record
•Document note in QMG’s record
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Improving Patient Care by…
Directly Admitting to Nursing Homes:
•Directly admit to NH when clinically indicated
•Communicate with ED physician and PCP ifadmission is appropriate
•Document initial encounter and provide initialNH admitting orders
•PCP to follow thereafter
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Improving Patient Care by…
Ordering Home Health, PT, OT, Etc.:
•Certain encounters have required new orcontinued orders for physical or occupationaltherapy
•Several encounters have given the opportunityfor home health care referral
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Barriers Encountered
•Initial resistance from hospital
•Heavy volume days
•Time delay for patients to show on census
•Unknown PCP status
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Success Stories
•88 year old female who is homebound
•56 year old male with intractable back pain
•The “chest pain rule out” patient
•Educating new parents on appropriate EDvisits
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Results
•Acceptance by Emergency Departmentphysicians
•QMG physician feedback
•Data
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Results
•145 patients have been assessed and notadmitted
–74 patients discharged that would have beenadmitted
–71 patients assisted in discharge
•20 average avoided admissions per month
•Average length of stay at Blessing Hospital is3.6 days
•Average estimated cost savings of $2,160,000annually
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Questions?