Systems Opportunities to Reduce ED Crowding From Nonemergency Referrals

Area of Science:

• Healthcare Management
• Patient Safety
• Quality Improvement

Background:

• Emergency department (ED) crowding is a critical issue impacting patient safety and mortality.
• A significant portion of ED visits are for nonurgent conditions, often stemming from provider referrals.
• Existing healthcare systems may lack adequate alternatives for nonurgent patient needs.

Purpose of the Study:

• To investigate the contribution of nonurgent referrals to ED crowding.
• To collaborate with an accountable care organization (ACO) to implement alternatives to ED visits.
• To evaluate the impact of these interventions on ED utilization.

Main Methods:

• Surveying nonemergent ED patients regarding prior medical contact and willingness to accept alternative appointments.
• Collaborating with ACO leadership on a multidisciplinary quality improvement initiative.
• Implementing increased alternative ambulatory resources based on study findings.

Main Results:

• 52% of nonemergent ED patients contacted a provider beforehand, with 70% being directed to the ED.
• 59% of patients would have accepted a clinic appointment instead of an ED visit.
• ED visits per 1000 ACO patients significantly declined after implementing alternative resources.

Conclusions:

• Nonurgent referrals are a significant driver of ED crowding.
• Implementing accessible, timely alternatives can effectively reduce ED visits.
• Multidisciplinary collaboration within ACOs can improve healthcare access and efficiency.