Fitting the Pieces Together
Utilizing a Hospitalist in the ED to
Reduce Admissions
Presented by:
Patty Williamson, CFO
Isidoros Vardaros, M.D.
4/8/2015
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Quincy Medical Group
• Multi-specialty medical group serving Quincy, IL and
surrounding tri-state area
• 100 Physicians, 135 Total Providers
• All primary care physicians are Level 3 NCQA PCMH
certified
• Blessing Hospital is independent and is not part of
the UnityPoint system
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Strategy = Triple Aim
• QMG’s strategic plan is the Triple Aim
• Focused on developing change agents within the
organization
• 3 physician led committees
– Quality – 5 physician led teams around diabetes,
hypertension, COPD, osteoporosis, and CHF
– Patient Satisfaction – providing transparent Press Ganey
results with a goal of achieving the 90th percentile
– Total Cost of Care – focused on reducing hospital
admissions
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10 Initiatives
1.
2.
3.
4.
5.
6.
After Hours Nurse Triage Phone Service via UnityPoint
Home Health Care via UnityPoint at Home
Expand ACC and/or Primary Care hours
Expand Infusion Center and Imaging hours
Hospitalist assessing patient in Emergency Room
Use Nurse Care Coordinator Model – BCBS Int. Medical
Home
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 final
admission or discharge is determined by ER
physician
• Compare labs/notes from QMG’s record and
hospital’s record to assess patient’s change in
medical status
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Logistics of the Practice
Service for QMG Patients:
• Exclusively for QMG patients
• Direct patient toward the correct admitting
physician or discharge to the primary care
provider
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Logistics of the Practice
Ages Served:
• Discharge patients as young as 6 months old
with 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 currently
in the ED under “ED Status”
• Directly assess patients once the ER physician
has completed their initial encounter
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8
U-Turn to Appropriate Care
Assess Patients with Status of:
• Inpatient Admission
• Observation Admission
• 30 Day Re-admission
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9
U-Turn to Appropriate Care
• Observation Status: Does not meet inpatient
criteria
• 30 Day Re-admission: Returns to ED less than
30 days from previous discharge
• Goal is to treat “observation” or “30 day readmission” patients in the outpatient setting
when appropriate
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10
Improving Patient Care by…
Educating Patients on Preferred Access Points:
• Scheduling appointments with specialists if
warranted
• Ordering future lab studies or investigative
procedure as an outpatient
• Scheduling PT / OT / Rehab / Home Health Care
when appropriate
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11
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 future
appointments
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Improving Patient Care by…
Scheduling Next Day Appointments:
• QMG schedule hotline
• Available during regular office hours to
schedule appointments
• Available on-call during hospitalist work hours
4/8/2015
13
Improving Patient Care by…
Care Coordination with Primary Care Physician:
• Work closely with ED physician and relate any
current outpatient labs / investigative
procedures
• 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 if
admission is appropriate
• Document initial encounter and provide initial
NH 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 or
continued orders for physical or occupational
therapy
• Several encounters have given the opportunity
for home health care referral
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16
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 ED
visits
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Results
• Acceptance by Emergency Department
physicians
• QMG physician feedback
• Data
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19
Results
• 145 patients have been assessed and not
admitted
– 74 patients discharged that would have been
admitted
– 71 patients assisted in discharge
• 20 average avoided admissions per month
• Average length of stay at Blessing Hospital is
3.6 days
• Average estimated cost savings of $2,160,000
annually
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Questions?
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