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HCD 502 #2

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by

Amy Chiang

on 4 December 2013

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Transcript of HCD 502 #2

Repeat Use of ED for Non-Emergent Care
Patient
Communities
Families
ED Staff
Hospital
Insurance
Emergency Services
PCP &Urgent Care Centers
Stakeholders
Start Point
Repeat Use
Healthcare for Non-Emergency Ex. PCP, Urgent-Care
No
YES
Population Categories
*Six-Sigma: Measure
*Six-Sigma: Analyze
*Six Sigma: Define
Self-perceived Acuity
Disposition
Discharged
from
Hospital
Admit to
Hospital
*Six-Sigma: Define
Goals
System Approach
Sun, B. C., Burstin, H. R., & Brennan, T. A. (2003). Table 3 Page 6
Evidence-based system assessment of repeat use of Emergency Departments for non-emergent care.
Six-Sigma framework and related tools to define and analyze the processes involved.
Determine the causes of the repeat use and possible solutions for reducing it.
Identify key stakeholders
System thinking

Six-Sigma framework and tools
-define -measure
-analyze -improve
-control
Built Environment
Lack of Primary care & urgent care clinics
ED accept, and at least assess, any patient who walks through the door.
Easier to reach and Open 24/7
Many PCP’s choose not to accept Medicaid/Medicare as payment
Within a community
Built Environment
Waiting rooms are often too small, uncomfortable, and not visually accessible by staff
Differentiated patient care areas help total throughput
Too few exam rooms to meet demand
Often not conducive to providing adequate patient education
Rooms laid out along long hallways or corridors
Within an ED
Hall, Kyriacou, Handler & Adams (2008); Michelen, Martinez, Lee, & Wheeler (2006)
Hall, Kyriacou, Handler & Adams (2008); Michelen, Martinez, Lee, & Wheeler (2006)
LaCalle, Rabin, & Gene. (2013)
System Change
Education at discharge
Case managers
Standardize ESI
References
Hall, K., Kyriacou, D., Handler, J., Adams, J. (March 2008). Impact of Emergency Department Built Environment on Timeliness of
Hunt, K. Weber, E.J., Showstack, J., Colby, D., Callaham, M. (July, 2006). “Characteristics of Frequent Users of Emergency Deparments”. Annals of Emerfency Medicine. 48(1).
LaCalle, E.J., Rabin, E.J., Genes, N.G. (2013). “High-Frequency Users of Emergency Department Care”. Journal of Emergency Medicine. 44(6).
Physician Assessment of Patients With Chest Pain. Environment and Behavior. 40(2). 233-248
Sun, B. C., Burstin, H. R., & Brennan, T. A. (2003). Predictors and outcomes of frequent emergency department users. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine. 10(4). 320-328.
A-Team
Hoot & Dominik Aronski (2008)
Full transcript