Northridge Hospital Medical Center – Emergency Department Initiative

The Emergency Department Initiative (EDI) is a collaboration between Northridge Hospital Medical Center and Tarzana Treatment Center (TTC) that began in 2004. TTC has extensive experience in primary care, HIV/AIDS, substance use disorders, and mental health. The objective of the collaboration is to reduce health disparities among populations with disproportionate unmet health-related needs, specifically individuals with alcohol and/or chemical dependency and mental health conditions. These individuals would be better served at clinics and need a medical home that addresses mental health, substance abuse and other health-related issues. The focus is on those patients who are uninsured or underinsured, have had three or more visits to the ED, and have a diagnosis related to drug/alcohol addiction and/or underlying psychiatric disturbances.

Overview

The Emergency Department Initiative (EDI) is a collaboration between Northridge Hospital Medical Center and Tarzana Treatment Center (TTC) that began in 2004. TTC has extensive experience in primary care, HIV/AIDS, substance use disorders, and mental health. The objective of the collaboration is to reduce health disparities among populations with disproportionate unmet health-related needs, specifically individuals with alcohol and/or chemical dependency and mental health conditions. These individuals would be better served at clinics and need a medical home that addresses mental health, substance abuse and other health-related issues. The focus is on those patients who are uninsured or underinsured, have had three or more visits to the ED, and have a diagnosis related to drug/alcohol addiction and/or underlying psychiatric disturbances.

Under this initiative, hospital personnel providing discharge services refer eligible patients to a part-time TTC case manager who works with patients requiring case management. This includes intake and assessment; individualized care planning; case conferencing with other coordinators of client care or services; and referral to ambulatory care, mental health care, substance abuse treatment, housing, and vocational services; and distribution of transportation vouchers and follow-up.

Impact

There were 646 patients with more than three ED visits prior to receiving Tarzana Treatment Center intervention, who were seen by the on-site case manager. There were 332 patients with three or more ED visits after receiving the TTC intervention. The percentage of patients who were admitted to the ED or hospital within three months after receiving the intervention was 51.4 percent, thus greatly reducing recidivism in the ED. Patients are connected to a primary medical home so they do not have to access the ED for care.

Patients with co-morbid mental health and substance abuse issues get connected to resources to help them deal with these issues (i.e., detox, rehab, and inpatient or outpatient mental health referrals); additionally, those that are homeless are connected to a housing navigator.

Lessons Learned

This partnership has significantly decreased frequent and “inappropriate” use of the ED. Referrals to community resources have been a key factor in helping patients who frequently use the ED. Sixty-two percent of patients were referred to primary care, 20 percent were referred to substance use disorder treatment, 5 percent were referred to mental health treatment, and 13 percent were referred for additional assessment, transportation, housing or other services.

Future Goals

Plans include expanding partnerships with shelters and housing agencies, which are greatly needed for continuum of care.

Contact: Brian Hammel
President, Northridge Hospital Foundation
Telephone: 818-885-5341
Email: brian.hammel@dignityhealth.org

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