By WSMA, Special for USDR
For several years the ER is for Emergencies coalition has been working to reduce preventable emergency room visits. This public-private partnership has not only improved utilization, quality of care and savings in Washington state, but the efforts of the coalition are getting national attention. The group recently adopted phase two of its Seven Best Practices program to reduce avoidable emergency room visits, integrating critical narcotic prescribing information with electronic medical records in emergency departments across the state.
The ER is for Emergencies coalition includes the Washington State Medical Association, Washington State Hospital Association, the Washington Chapter of the American College of Emergency Physicians and the Washington State Health Care Authority.
The ER is for Emergencies campaign attempts to address the root of the problem of emergency room overuse—including chronic medical conditions, substance abuse issues and lack of primary care access—by focusing on frequent users, using targeted strategies such as patient education, improving access to primary care and encouraging physician participation in the state’s Prescription Monitoring Program, which tracks data on patients who are prescribed controlled substances.
Washington is the first state in the nation to integrate information from the PMP into the electronic medical records of an emergency department. This critical information allows physicians to know which drugs the patient has been prescribed and can help prevent an emergency department from prescribing medications that may contribute to drug interactions or overdoses.
Since 2012 the ER is for Emergencies coalition has released two reports showing its success. The most recent report, for fiscal year 2013, showed:
- The rate of emergency department visits declined by 9.9%.
- The rate of “frequent visitors” (five or more visits annually) dropped by 10.7%.
- The rate of visits resulting in a scheduled drug prescription fell by 24%.
- The rate of visits with a low-acuity (less serious) diagnosis decreased by 14.2%.
- A savings of $33.6 million in Medicaid fee-for-service emergency care costs.
Improving access to health care for the citizens of Washington includes directing them to the most appropriate and most cost-effective place to receive care, whether it’s a primary care office, urgent care center or emergency department. Reducing preventable emergency room visits benefits everyone—patients, physicians, hospitals and the state budget.
The seven best practices are:
- Adopt statewide electronic health information system to coordinate care plans of patients with high needs (five or more visits to ER per year) with emergency rooms, payers, mental health clinics and primary care providers.
- Disseminate patient education materials to help patients understand appropriate resources for care.
- Identify frequent users of the emergency department and emergency medical services and develop and coordinate case management, including utilization of care plans.
- Develop patient care plans for frequent ER users.
- Reduce drug-seeking and drug-dispensing to frequent ER users.
- Encourage emergency physician enrollment in the state’s Prescription Monitoring Program to ensure coordinate of prescription drug prescribing practices.
- Use feedback information to review reports of frequent ER users to ensure interventions are working.