ED Community Placement Project (EDCPP): Right Service-Right Venue Approach in Managing ED Frequent Users
Mitchell, Karen Elizabeth
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Session presented on Saturday, July 26, 2014: ED Community Placement Project (EDCPP): Right Service -Right Venue approach in managing ED frequent users. Karen Elizabeth Mitchell, RN, MSN,CMCN, Department of Emergency Medicine, University of California San Diego Health System, San Diego, CA 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.