Coordinating care for frequent visitors in already crowded Emergency Departments (EDs) is a unique challenge for both clinicians and administrators alike. This article explores the innovative Medical Management Program implemented by the Lakeland Regional Medical Center, which provided individualized care plans for frequent visitors presenting to the ED with chronic medical conditions.
Lakeland Regional Medical Center, an 851-bed, not-for-profit hospital located in Lakeland, Florida developed a Medical Management Program in order to decrease frequent visitors with chronic medical conditions in the Emergency Department (ED). Annually, this Trauma Level 2 hospital's ED sees about 172,000 patients. The multidisciplinary team consisted of ED staff, nurses, pharmacists, physicians, and registration staff. Individualized care programs were developed because of the strain that frequent ED visitors create for the hospital and the healthcare system in general. When patients come into the ED to solve chronic care conditions, they are often receiving subpar quality healthcare treatments that could be majorly improved through the use of primary care and patient centered medical home treatment options. In addition, ED care is cost0intensive for both the hospital and the patients. It is more cost-effective for chronic conditions to be treated through individualized treatment plans. Therefore, Lakeland Regional Medical Center created a standardized care plan for these patients in order to improve patient quality of life and decrease the number of ED visits. The major goal of the program was to decrease the rate of readmission to the ED in those patients identified to have high rates of utilization and readmission.
The multidisciplinary team consists of:
- 2 Physicians (ED Medical Director and the Chief Quality and Medical Information Officer): Approved the final patient plan
- 2 Pharmacists (ED pharmacists and the hospital pain management pharmacists): Provided care plan recommendations to the physicians, assisted with medication properties expertise, and met with patients to discuss their care plan
- 1 ED Nurse Manager: coordinated quarterly meetings, researched patient referrals to the program, and ensured individualized plans are updated in the EMR
The team reviewed ED data for the last 6 months and selected patients with multiple ED visits. After reviewing each patient's medical record, the multidisciplinary team created an individualized plan of care, based on the patient's number of recent visits, reason of visit, past medical history, medication history, ED treatment history, previous diagnostic work-up, in-patient admission history, primary care provider status, and allergy information. The care plan was linked with the patient's EMR record, which provided ease of data use and care coordination between clinicians and patients.
Results of the program consisted of data for patients enrolled in the Medical Management Program from September 2009 through July 2012 (a total of 63 patients). This data included a wide range of criteria including date of enrollment, number of visits prior and post 6 months to enrollment, and number of visits during the 6-12 month period following enrollment. Overall, the program saw that there was a significant decrease of ED visits (57%) per month per patient. In addition, data analysis also showed sustained decrease in revisits: a significant 78% decrease (or 2.5 visits) per month absolute decrease in the number of average visits per month.
The backbones for success in this program consisted of: the electronic health system, a multidisciplinary team, and nurse leadership. Physician leaders label the treatment plans with "authority" which allows treating physicians to intervene whenever care is not being provided at the optimal level. In addition, the study found that many patients were initially reluctant to follow the treatment plans but increasingly observed a higher quality of life throughout the program, thus more unlikely to visit the ED.
Needless to say, this program proved to be a success at Lakeland Regional Medical Center and provides an excellent point of reference for hospitals suffering from the same ED problems. With the changing healthcare landscape, most importantly the shift from volume to value, healthcare professionals have to keep in mind the penalties associated with readmissions and low quality healthcare. Establishing a Medical Management Program in an ED is an innovative technique to decrease frequent ED users and save costs for the organization at large.
Sonia Malik, MHA Candidate at the George Washington University, Research Assistant at Urgent Matters