By Jessica Kent
July 25, 2019 - In its tireless pursuit of better care at lower costs, the healthcare industry has consistently made unnecessary emergency department (ED) visits, hospital readmissions, and drug prescriptions primary targets for improvement.
These care episodes cost billions each year, and often lead to poorer outcomes and lower-quality care, especially for patients who may need more comprehensive primary care.
At CHI St. Anthony Hospital, an acute care organization based in Pendleton, Oregon, providers and staff were all too familiar with these issues.
Steve Hardin, RN, BSNSource: Xtelligent Healthcare Media
In 2015, the hospital was seeing an extremely high rate of ED super users, many of whom were suspected opioid seekers. Readmissions were also common, with patients returning to the hospital just weeks after being released.
“Our ED was seeing about 37 patients a day—which may not sound like a lot, but for a 25-bed critical access hospital, that’s significant and not sustainable,” said Steve Hardin, RN, BSN, ED manager at CHI St. Anthony.
READ MORE: Patient-Reported Data on Readmissions, Complications is Accurate
“An analysis showed that at least 50 percent of these patients would be better suited to a lower acuity setting,” he added. “We needed a way to easily identify patients better suited for primary care and support those struggling with or at-risk for substance use disorder. Our baseline rate of all-cause readmissions was also at eight percent, and we wanted to uncover the reason behind this.”
The organization soon implemented a real-time data system to track and monitor ED utilization and readmissions. The platform seamlessly integrates with CHI St. Anthony’s EHR to help providers identify and manage complex patients with a history of high utilization, substance use disorder, known social determinants, and other risk factors.
“When patients present at the ED, the platform automatically generates a real-time notification for at-risk patients—including details about frequency of ED visits, medication histories, care guidelines, and potential security risks—sourced by the patient’s broader care team,” Hardin said.
“It’s not only helped us identify why our ED utilization rates were so high, but increased our collaboration with other hospitals, clinics, and primary care providers—strengthening the quality of information we’re sharing with one another.”
The system revealed that chronic conditions were an underlying cause of high utilization, allowing providers to adjust their treatment strategies and give patients the support they need.
READ MORE: Cognitive State Impacts Chronic Disease Management, Readmissions
“With the platform, we’ve found that patients with COPD or congestive heart failure were the top groups contributing to those readmission numbers,” Hardin explained. “These patients weren’t being given adequate care instructions when they were discharged, so they’d usually show back up within 30 days of their initial visit.”
Once they altered their approaches to account for patients’ unique situations and conditions, CHI St. Anthony was able to significantly decrease expensive care episodes.
“After 18 months of using the platform, we reduced our unnecessary ED visits by high utilizers from 17 percent to 4.25 percent. We’ve also cut our readmission rate from eight percent down to 1.72 percent,” he said.
“Additionally, because we were able to free up staff time and resources in the ED, we reduced our ‘left-without-being-seen’ rates down from six percent to two percent,” Hardin added. “We also decreased the number of prepack prescriptions coming out of the ED by 60 percent, subsequently saving $200,000.”
In addition to hospital readmissions, ED visits, and drug prescriptions, the organization has leveraged the system to alleviate safety and security concerns.
READ MORE: How Many Emergency Department Visits are Really Avoidable?
“We’ve started using the system to track and report workplace violence, which is pretty common in emergency medicine,” said Hardin.
According to the American College of Emergency Physicians, 47 percent of emergency providers report being physically assaulted while working in the ED, with more than 60 percent saying that these assaults had occurred in the past year.
After seeing the success of the real-time data system, CHI St. Anthony saw an opportunity to boost patient and provider safety by monitoring the amount of workplace violence happening in the ED.
“I thought that if we could start documenting the violent incidents that were occurring, the hospital would recognize there was a problem,” Hardin said.
“For a year and a half, we’ve been working with our ED staff to document these incidents in reports and on the platform, and we’ve seen a 20 percent increase in security events logged. Corporate has since allowed us to get security, and we’re sending staff to de-escalation, violence prevention, and restraint classes – all because we took the time to document things.”
The system at CHI St. Anthony has allowed clinicians to transform care delivery for the better.
“In the few years that we’ve used the platform at St. Anthony, it’s been instrumental in providing our patients with better care and cutting costs,” said Hardin.
“In the ED, we often have to make quick decisions with limited information. We don’t have the luxury of time because this patient’s life is in our hands and there’s a full waiting room outside. If some of these patients could be better served in primary settings, we need the information to make that happen.”
After seeing the difference that real-time data can make, Hardin noted that this information will be critical to achieving better outcomes at lower costs.
“The scope of real-time data is all encompassing. I can use it to treat a patient in the ED, but if I can access rich, meaningful data that’s been contributed from all points of care, that’s huge,” he concluded.
“Real-time data is allowing us to look at a patient’s holistic health and connect them to support systems that develop care plans and communicate on behalf of the patient and their needs. It’s all about identifying details to enact change—if you can capture the details, you can manage them.”