Karen Elizabeth Mitchell, RN, MSN,CMCN
Department of Emergency Medicine, University of California San Diego Health System, San Diego, CA
Abstract Title:“ED Community Placement Project (EDCPP): “Right Service -Right Venue” approach in managing ED frequent users.
Authors:Karen Elizabeth Mitchell, RN, MSN, CMCN, Christian Tomaszewski, MD, MBA, and Catherina Mandani, RN, MSN, PhD(c).
Background Statement:San Diego has the 3rd largest homeless population in the United States, following New York and Los Angeles. Homeless patients without medical homes account for nearly 1/3 of the ED visits, resulting in longer ED wait times and avoidable inpatient admissions. Many of these patients are non-funded or under-insured contributing to rising unreimbursed healthcare costs. Emergency departments (ED) are ill equipped to meet the psychosocial, housing, substance abuse treatment and mental health needs of homeless community.
Intervention Detail:The “Emergency Department Community Placement Project” (EDCPP) is designed to bridge the highest ED users into community-based homeless prevention services, substance abuse treatment, and intensive case management. The goal for this project is to reduce recidivism amongst the neediest and costliest patients by 20% through provision of resources to address substance abuse, homelessness and mental health issues.
A cohort of 215 patients was electronically pre-identified in EPIC electronic medical records. Inclusion criteria included homeless with frequent ED visits (2 or more visits per month over the past 12 months) and associated complaints of co-occurring disorders, substance abuse and alcohol related illness. Upon patient presentation the Best Practice Advisory (BPA) flag is initiated and triggers targeted interventions. The ED physician / psychiatrist places “Community Placement Order”. Patient consenting, screening and placement (to community partners) are performed by ED Staff.
Setting and methods: Emergency Department is an urban, academic teaching healthcare facility. Annually treating 42,300 patients.
Results: Six month analysis: Cost savings of $168,231. Based on program expenses, (contractual bed cost) of $38,234 (6mos) = 4 .4 (ROI). 78 % reduction in ED visits among EDCPP placed patient cohort. 3.8% increase in Press-Ganey patient satisfaction scores. Given results, program planned for expansion to other healthcare system EDs and extended pt populations.