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. 2017 Aug;18(5):870-877.
doi: 10.5811/westjem.2017.5.33593. Epub 2017 Jul 14.

Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions

Amanda S Carmel  1 , Peter Steel  2 , Robert Tanouye  2 , Aleksey Novikov  1 , Sunday Clark  2 , Sanjai Sinha  1 , Judy Tung  1
Affiliations

Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions

Amanda S Carmel et al. West J Emerg Med. 2017 Aug.

Abstract

Introduction: Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center.

Methods: We conducted a retrospective review of patients referred from the ED to primary care (Weill Cornell Internal Medicine Associates - WCIMA) through a rapid-access-to-primary-care program developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals were classified as either an avoided admission or not, and classifications were performed by both emergency physician (EP) and internal medicine physician reviewers. We also collected outcome data on rapid visit completion, ED revisits, hospitalizations and primary care engagement.

Results: EPs classified 26 (16%) of referrals for rapid primary care follow-up as avoided admissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapid appointment. There were no differences in rates of ED revisits or subsequent hospitalizations between those who attended the rapid follow-up and those who did not attend. Patients who attended the rapid appointment were significantly more likely to attend at least one subsequent appointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8 (18%), P=0.001].

Conclusion: A rapid-ED-to-primary-care-access program may allow EPs to avoid admitting patients to the hospital without risking ED revisits or subsequent hospitalizations. This protocol has the potential to save costs over time. A program such as this can also provide a safe and reliable ED discharge option that is also an effective mechanism for engaging patients in primary care.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This work was funded by internal funds from Weill Cornell Medical College.

Figures

Figure
Figure
Patients referrals and outcomes. ED, emergency department; PCP, primary care physician.
See this image and copyright information in PMC

References

    1. Greenwald PW, Estevez RM, Clark S, et al. The ED as the primary source of hospital admission for older (but not younger) adults. Am J Emerg Med. 2016;34(6):943–7. - PubMed
    1. Lee TH. Putting the value framework to work. N Engl J Med. 2010;363(26):2481–3. - PubMed
    1. Smulowitz PB, Honigman L, Landon BE. A novel approach to identifying targets for cost reduction in the emergency department. Ann Emerg Med. 2013;61(3):293–300. - PubMed
    1. O’Malley AS. Current evidence on the impact of continuity of care. Curr Opin Pediatr. 2004;16(6):693–9. - PubMed
    1. Bodenheimer T. Coordinating care--a perilous journey through the health care system. N Engl J Med. 2008;358(10):1064–71. - PubMed

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