Based on a conversation with and information provided by Lindsey Yourman, M.D.
In July of 2012, Massachusetts General Hospital (MGH) rolled out its Acute Care Plan (ACP) program in its Emergency Department. The team at MGH developed ACPs to improve the coordination of care for high frequency emergency department (ED) patients. These plans are notes connected to their ED Information System, which give quick guidance to ED clinicians regarding the patient’s treatment plan, disposition, and who to contact if the patient is in the ED. They were created to address the lack of coordination among outpatient providers and ED providers, particularly for these complex patients. ACPs are special treatment plans integrated within a patient’s record with information from the patient’s primary care provider, case manager, or another clinician to help guide treatment decisions should the patient end up in the ED. ACPs are automatically flagged in the ED Information System (EDIS) when a patient arrives to the ED. With an ACP, patients may avoid unnecessary testing and/or admissions, as there is seamless documentation of the patient’s risk factors and history Since implementation, the number of visits and length of stay for high frequency ED patients selected to have an Acute Care Plan have decreased. Their initial analysis demonstrated some positive results. Comparing 1 year prior to the ACP and 1 year after the ACP, there was a 39% decrease in ED visit volume among this high utilizer population (a net decrease of 565 visits). Approximately 70% of patients who had an ACP experienced a decrease in ED visit volume in the year following the ACP. 60% of patients with an ACP experienced a decrease in ED LOS. The number of hospital admissions decreased by 48% for patients with an ACP (a net decrease of 143 admissions). The overall admit rate among this population decreased by 14%, from 20.8% to 17.9%.
In 2016, there were a total of 63,979 intentional injury deaths in the United States. Of these, 37,353 (58%) involved a firearm: 22,938 (36%) were intentional self-harm deaths and 14,415 (23%) were assault-related deaths. Since 1999, firearm violence injury death rates have increased by 17%. Comparatively, traffic-related death rates have decreased by 22%. In addition to mortality, firearm violence injury exerts an annual burden of over $2.8 billion on the healthcare system.
Every year thousands of people in Oakland California arrive at the ED in the acute stages of opioid withdrawal.1 Opioid withdrawal, an agonizing process that involves vomiting, diarrhea, shivering and pain, has historically been treated with an anti-nausea table, a
In October of 2015 Joshua J. Lynch, DO, a clinical assistant professor of emergency medicine in the Jacobs School and a physician with UBMD Emergency Medicine, read a paper that introduced him to the idea of Emergency Department based medication assisted therapy (MAT). The paper, published at Yale concluded that patients who were given buprenorphine in the ED and provided with a clinic appointment were the most likely to be in treatment a month later and the most likely to have reduced their opioid use. As an emergency room physician in a region of New York, where that year 800 people would die from opioid overdoses alone, Lynch jumped at the opportunity to do more for these patients than simply hand them brochures of treatment options (the standard of care at the time).
In 2010, Ohio became the state with fourth highest rate of overdoses in the US, a title which it defended until becoming number three in 2016 and number two the following year.1 While victims increase in number, they decrease in age. This past year the population of Ohio lost a collective 500,000 years.2 This trend is prominent in the northeast, a region of Ohio hit so hard by the opioid epidemic that funeral home revenues are reported to have spiked.3 However, a small community hospital in Summit County is fighting back.
The emergency department has become a prominent battle-ground for our nation’s opioid epidemic. The CDC estimates that between July 2016 and September 2017 over 140,000 patients visited an ER for overdose nationwide.