PLEASE NOTE: THIS RESOLUTION WILL BE DEBATED AT THE 2013 COUNCIL MEETING.RESOLUTIONS ARE NOT
OFFICIAL UNTIL ADOPTED BY THE COUNCIL AND THE BOARD OF DIRECTORS (AS APPLICABLE).
RESOLUTION:
36(13)
SUBMITTED BY:
Illinois College of Emergency Physicians
SUBJECT:
Development of a Rapid Integration of Care Toolkit
PURPOSE: Develop a rapid integration of care toolkit to focus on transitions of care and care coordination,
provide best practices based upon hospital type and location, tools/resources for the design and implementation of
rapid integration of care programs, and measures to report success of efforts.
FISCAL IMPACT: $15,000 includes research, consultant to develop rapid integration of care toolkit with
measurement tools, dissemination and promotion expenses, staff time, and resources.
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WHEREAS, Emergency physicians are key decision makers for nearly 50% of all hospital admissions
and emergency medicine can play a critical role in reducing health care costs while improving patient-centered
care and transitions of care; and
WHEREAS, Emergency medicine providers currently serve as the ideal system navigator; and
WHEREAS, Lack of access to follow-up care is a top concern of emergency physicians; and
WHEREAS, Emergency departments function at the interface between outpatient and inpatient care, have
access to advanced diagnostics and treatment technology, are staffed 24 hours a day, and serve as the primary
safety net for healthcare; and
WHEREAS, The evolving roles of emergency departments in the spectrum of healthcare are changing
including the growing use of EDs as diagnostic centers and recognition that EDs are the primary entry point for
unscheduled hospital admissions, and that there is a great opportunity to formally integrate EDs into health care
delivery systems; and
WHEREAS, Rapid integration of care programs are not uniformly in place in many emergency
departments and guidelines for establishing such protocols are not readily available; and
WHEREAS, There has not been a plan created to provide emergency departments with tools to
implement state-of-art care coordination /transitions of care protocols; and
WHEREAS, The ACEP Transitions of Care Task Force has recommended that a web-based toolkit that
includes resources, assessment and support tools, and best practices be developed; therefore be it
RESOLVED, That ACEP develop a rapid integration of care toolkit that would focus on both transitions
of care and care coordination, provide best practices based upon hospital type and location, tools/resources for the
design and implementation of rapid integration of care programs, and measures to report success of efforts.
Background
This resolution calls for the College to develop a rapid integration of care toolkit to focus on transitions of care
and care coordination, provide best practices based upon hospital type and location, tools/resources for the design
and implementation of rapid integration of care programs, and measures to report success of efforts.
Resolution 36(13) Development of a Rapid Integration of Care Toolkit
Page 2
Care coordination is an approach to health care in which all of the patient’s health care needs are coordinated with
the assistance of a primary point of contact. The point of contact provides information to the patient and the
patient’s caregivers and works with the patient to ensure that the patient gets the most appropriate treatment,
while ensuring that health care services are not unnecessarily duplicated. Care coordination saves money on
health care costs as has been demonstrated by a number of care coordination pilot projects and it improves the
quality of care as well as patient satisfaction.
The National Quality Forum (NQF) states that care coordination is a vital aspect of health and health care
services. NQF has endorsed a portfolio of care coordination preferred practices. These standards provide
structure, process, communication, and measurements.
Transition of care is defined as transfers of information, responsibility, and authority as patients move among
health care practitioners, settings, and home as their care needs change. In the emergency department (ED) these
transitions can be referred to as “handoffs, changeover, signout, and signovers,” but the goal is the same: to allow
subsequent providers to act safely in the patient’s best interest. As noted in the ACEP Transitions of Care Task
Force report from September 2012, there are three distinct, simultaneous dimensions in transitions of care.
Information transfer: This includes relevant medical history, details of acute illness, physical examination
findings, vital signs, laboratory test results, treatments received and pending and diagnostic examinations
completed or in progress. Responsibility transfer: At the time of changeover, the incoming provider accepts
responsibility for the patient’s ongoing care needs. This includes legal responsibility and accountability.
Authority transfer. The new provider also accepts primary authority over continued care, effectively becoming
the patient’s care provider until the next care transition.
The Agency for Healthcare Research and Quality (AHRQ) provides a transition of care guide that helps health
care institutions develop and implement processes for sending and receiving patients from one care setting to
another. The information and plans provided allow institutions to measure their performance in transitions of care
and identify areas for improvement.
Topics covered include:
Evaluating and improving transitions of care in your institution
Nursing home to emergency department (ED)/hospital transfer
Appendices
Appendix A: Emergency medical services (EMS)/ambulance transfer of patient from a nursing home to
hospital
Appendix B: Hospital receipt of patient from nursing home
Appendix C: ED/hospital to nursing home transfer
Appendix D: EMS transport of patient to nursing facility
Appendix E: Nursing home receipt of patient from the hospital
Appendix F: Evaluation: a basic primer
Appendix G: Literature review - transitions from the nursing home to the hospital
Appendix H: Institute for Healthcare Improvement tips for effective measures
Appendix I: National Transitions of Care Coalition (NTOCC) tools
Appendix J: NTOCC proposed framework for measuring transitions of care
In June 2012, The Joint Commission (TJC) Center for Transforming Healthcare developed tools and resources for
implementing a model system to support transitions of care. TJC also provides a tool that describes factors that
contribute to incomplete handoffs and recommends tactics to improve handoff communication.
The National Transitions of Care Coalition (NTOCC) offers practitioners assistance in addressing transitions of
care in their facility and a compilation of practical tools for assessing, measuring promoting and improving the
quality of health care.
The Transitions of Care resource page on the ACEP Web site includes the full report from the Transitions of Care
Task Force, ACEP articles on this topic, and a video regarding communication with consultants in the ED.
Resolution 36(13) Development of a Rapid Integration of Care Toolkit
Page 3
The Transitions of Care Task Force report includes the recommendation that ACEP develop a web-based toolkit
that includes resources, assessment and support tools, and best practices.
ACEP Strategic Plan Reference
Goal 1 – Reform and Improve the Delivery System for Emergency Care
Objective A – Develop and promote delivery models that provide effective and efficient emergency
medical care in different environments.
Tactic 1 – Promote standardization for transitions of care reporting /communication.
Tactic 2 – Promote the value EM brings to the coordination of care and case management.
Fiscal Impact
$15,000 includes research, consultant to develop rapid integration of care toolkit with measurement tools,
dissemination and promotion expenses, staff time, and resources.
Prior Council Action
Amended Resolution 22(11) Emergency Medicine and Transitions of Care adopted. Directed ACEP to define the
role of emergency medicine in transitions of care for emergency medicine patients; to participate in all significant
forums of discussion with regulatory entities, Department of Health and Human Services, Centers for Medicare &
Medicaid Services, The Joint Commission, National Quality Forum, related to performance parameters and
proposed standards for emergency medicine transitions of care; to monitor and have input into any reimbursement
issues tied to transitions of care, including performance incentives and accountable care organization
collaboration; and to identify resources and educational materials to improve transitions of care for emergency
patients.
Substitute Resolution 34(07) Patient Support Services Addressing the Gaps adopted. Stated that the College
supports that hospitals develop resources to improve emergency department patients’ access to outpatient
community health and support services.
Prior Board Action
October 2012, accepted the report of the Transitions of Care Task Force.
October 2012, accepted the report of the Cost Effective Care Task Force.
Resolution 22(11) Emergency Medicine and Transitions of Care adopted.
April 2008 approved policy “Definition of Emergency Medicine.” Originally adopted March 1986; approved
April 1994; reaffirmed October 1998; revised and approved April 2001.
Resolution 34(07) Patient Support Services Addressing the Gaps adopted.
Background Information Prepared By: Marilyn Bromley, RN
Emergency Medicine Practice Director
Reviewed By: Marco Coppola, DO, FACEP, Speaker
Kevin Klauer, DO, EJD, FACEP, Vice Speaker
Dean Wilkerson, JD, MBA, CAE, Council Secretary and Executive Director