Implementing Emergency Room Best
Practices:
Improves Care, Reduces Costs
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Speakers
• Representative Eileen Cody, R.N.
– Chair, House Health Care & Wellness Committee
• Stephen Anderson, MD
– Washington Chapter – American College of Emergency
Physicians
• Nathan Schlicher, MD, JD
– Washington State Medical Association
• Carol Wagner, R.N.
– Senior Vice President for Patient Safety, Washington State
Hospital Association
• Dan Lessler, MD
– Chief Medical Officer, Washington State Health Care Authority
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Why ER is for Emergencies?
• Some patients visiting emergency
departments could be treated effectively in a
less costly setting
• There are evidence-based practices that can
reduce low-acuity emergency room visits,
coordinate care, and save health care dollars
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Creating the Partnership:
Government
• In 2012, the Legislature passed
House Bill 2127
• Requires all Washington hospitals
to implement seven best
practices
Keys to Successful State Initiatives
• Evidence-based
• Measurable
• Achievable benchmark, possible for everyone
to succeed with commitment and hard work
• Clear positive outcomes
• Strong partnerships
Creating the Partnership:
Coordinating Care
• Washington State Hospital Association
• Washington State Medical Association
• Washington Chapter of the American College
of Emergency Physicians
• Washington State Health Care Authority
Power of a Statewide Goal
• Standard policies in every hospital
– No patient shopping for a different physician
• Safe Table Learning Collaboratives to share
best practices
• Friendly competition towards a shared goal
Seven Best Practices
1. Track emergency department visits to avoid ED
“shopping”
2. Implement patient education
3. Institute an extensive case management program
4. Reduce inappropriate ED visits by collaborative use of
prompt visits to primary care physicians
5. Implement narcotic guidelines to discourage narcoticseeking behavior
6. Track data on patients prescribed controlled substances
7. Track progress of the plan to make sure steps are working
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Project Impact
• 98 hospitals now sharing emergency room
information electronically
• 97 hospitals developed and use a standardized
care plan format, providing consistent care no
matter where a patient goes
• Expansion of care coordination efforts to all
frequently utilizers, regardless of payer
• Instant notification of Primary Care Providers
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Innovations
• Newport Hospital integration of mental and
physical health into primary care
• PMH Medical Center community based
paramedic program
• Kitsap Community Mental Health Center
enhanced relationship with local medical
center
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Reduced ED visits by 9.9%
Rate of ED Visits
per 1000 Medicaid Clients
50
48
46
44
42
40
38
36
34
32
30
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Reduced number of visits by
frequent clients by 10.7 %
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Reduced visits resulting in a narcotic
prescription by 24%
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Reduced low-acuity visits by 14.2%
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Results: Better Care & Significant
Savings
“Given the apparent success of the Seven Best Practices
in reducing ED utilization and the rate of ED-related
opiate prescribing, HCA will work with hospitals and
health plans to sustain these efforts.”
- Health Care Authority January 2014 Report to the Legislature Emergency
Department Utilization: Assumed Savings From Best Practices Implementation
Savings of $33.65 million were achieved through
reductions to the Health Care Authority budget.
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Ongoing Barriers to Care
• Mental Health
Among high utilizers of ER services,
80% have mental health issues
• Access to Dental Care
Restoration of adult dental for Medicaid
Patients
• Access to Primary Care
Expanded medical health homes
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Next Steps
• Maximize benefit of integrated care and plan
of care as patients leave the hospital
– Primary care
– Payors
• Integrate information into medical records
across the care continuum
• Enhance utilization of the prescription
monitoring program
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How the Public Can Help
• Only go to the ER for emergencies
• If you aren’t sure, call the nurse line or your
primary care physician
• For ear aches and sore throats, make an
appointment with your primary care physician
• When you have a doctor’s appointment, ask
what you should do if you need care after
hours or on weekends
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Questions & Comments
• Full report: www.hca.wa.gov/leg_reports.html
“This is the kind of creative thinking, new approaches and
collaboration that I want to foster in health care. Not only is
the system saving money and physicians’ time, it is also
improving the quality of care by making sure patients
receive treatment that is both appropriate and timely.”
- Governor Jay Inslee
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