The influenza, RSV and COVID-19 tripledemic. An increase in mental health visits. An overworked staff and shortage of inpatient beds. All of these factors contribute to hospital emergency departments becoming overcrowded to dangerous levels.
The problem is so severe that medical groups, including the American College of Emergency Physicians (ACEP) and the American Medical Association (AMA), had written to President Biden about their concerns.
Fortunately, hospital and health system leaders have another option for expanding ED capacity without waiting for legislative changes. DispatchHealth can help now, and as a safe guard against future capacity constraints, with our innovative ED-to-Home program.
The case for ED-to-Home
DispatchHealth designed the ED-to-Home program to help solve ED and hospital overcrowding challenges. The program serves patients who are stable enough to discharge from the ED but need follow-up evaluation and care from a provider soon after discharge. ED-to-Home brings hospital-level care to medically complex patients within 72 hours of discharge.
The goal is to reduce post-discharge bounce-backs and ED recidivism among those who are returning home. Primary indications for ED-to-Home transitional care include congestive heart failure, urinary tract infections, dehydration, asthma and COPD, cellulitis, COVID-19 and pneumonia.
Data supports the need for ED-to-Home services:
- The American Hospital Association says that more than 33 million patients transition from U.S. hospitals each year. (1)
- Of those, 20% of elderly patients return to the hospital within 30 days. (2)
- According to the Centers for Medicare & Medicaid Services (CMS), these patients can cost Medicare up to $26 billion per year. (3)
- Medicare could save more than $17 billion of those dollars if patients received the right kind of transitional care. (4)
How ED-to-Home works
“Once we’re in the home, our provider will conduct a full history and physical exam, document that information, and provide any medical or symptom management that the patient may need,” says Garet Free, Vice President of Partner Success and Strategy at DispatchHealth. “We conduct medication reconciliation, arrange to fill the patient’s prescriptions, and evaluate their health literacy – their ability to understand their condition and treatment plan.”
“We will also assess their social determinants of health to evaluate any factors that may affect the patient’s health outcomes. And we ensure the patient has a follow-up visit scheduled with a PCP or specialist. If we come across issues that need PCP input, we call the provider while we are still in the home.”
“We have the ability to perform point-of-care labs, medication administration, IV fluids, wound care, catheter management, EKGs and so much more,” adds Carlton Stadler, MD, Eastern Regional Medical Director for DispatchHealth. “Our team is there for 30-45 minutes to listen to and understand all of the patient’s medical problems and provide the necessary care coordination.”
“It’s important that hospitals and health systems realize that we are not primary care providers, but rather an extension of the primary care physician’s office. The team completes their ED-to-Home clinical notes within 24 hours and sends those notes to the patient’s PCP, closing the loop for our patients.”
ED-to-Home success at Inova
Inova Health System is a five-hospital network in Northern Virginia, with a catchment area of more than 2 million patient lives. Inova partnered with DispatchHealth to implement ED-to-Home and ease the burden on their ED teams across the system.
“Our physician and operational leaders within Inova felt that ED-to-Home was the right thing to do,” says Tanveer Gaibi, MD, MBA, Inova System Division Chief of Emergency Medicine. “We had to find alternate ways to create capacity.”
“One of the things we really enjoy in our partnership with DispatchHealth is the flexibility. During the COVID-19 Omicron peak last year, we were full in the ED, and we are seeing it again now. [Last year] we needed to begin thinking about alternative ways to expand our capacity and reimagine how to best treat patients in the home,” explains Dr. Gaibi.
“DispatchHealth came onsite, attended staff meetings and worked with us to streamline the workflow. The rates of patients in the program returning to the ED are low, and DispatchHealth does a great job of making sure the patients are plugged back into Inova. We view DispatchHealth as a partner who is representing us in our competitive market.”
“Patients are getting really good care. They are really happy using DispatchHealth. We have a net promoter score of 98 from ED-to-Home patients.” Dr. Gaibi continues. “We’ve had many of our Inova family use DispatchHealth themselves. The feedback has been that they’re professional, they’re courteous, they come on time.”
“When we present it [ED-to-Home] to our patients, we tell them we have a great resource that can keep them out of the hospital. That we have a partner who can see them at home and communicate back to Inova about their needs. DispatchHealth provides another tool in the toolkit as we are forced to reimagine healthcare.”
Inova ED-to-Home Outcomes Data
*Source: Jan-Oct, 2022 DispatchHealth data
Implementing an ED-to-Home rollout
Implementing ED-to-Home in a hospital or health system is a physician-led project requiring support from executive leadership. We can complete an implementation in as few as three months, with DispatchHealth working side-by-by with the ED team — from scoping and workflow design to provider education and launch.
“Carlton, Garet and the rest of the DispatchHealth team made a visible attempt to be present,” says Dr. Gaibi. “They came to the Inova EDs and learned about our providers’ concerns. Carlton, who is an ED physician, even shadowed me to understand any potential barriers to implementation.”
Clear communication with hospitalists and ED staff is essential to a successful rollout, as is an early focus on EMR platform integration and optimization. It’s also critical to revisit the ED-to-Home program regularly to study the metrics and provide data transparency on the outcomes.
Learn more about DispatchHealth’s ED-to-Home program and see how Inova was successful in offering their physicians a hedge against ED volume overload.
References:
1 American Hospital Association, Fast Facts on U.S. Hospitals, 2022
2 Agency for Healthcare Research and Quality, PSNet, Readmissions and Adverse Events After Discharge
3 Centers for Medicare & Medicaid Services, Community-based Care Transitions Program
4 RevCycleIntelligence, Preventable Readmissions Cost CMS $17 Billion
