Emergency Department Case Management Program to Reduce High-Frequency Patient Utilization for Hospital and Community

An ED case management program was developed to implement tactics focused on reducing ED avoidable ambulance transfers, ED visits and hospitalizations for patients who used the ED more than 10 visits per year.

For a defined group of high-frequency patients, interventions by a nurse-led case management program resulted in fewer ED visits to the hospital and other community hospitals, fewer overall ambulance runs and fewer inpatient hospital stays. These fewer ED encounters and hospitalizations translated to savings for the payers of care.

Point-of-service case management deployment tactics such as comprehensive case evaluation to identify care barriers, education of patients, families and providers, as well as patient linkage to a sustainable medical home, are a few of the key activities deemed effective at directing health care services for this population.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state. These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)