Development of an Emergency Department Case Management Case-Finding Tool

Area of Science:

• Healthcare Management
• Quality Improvement
• Patient Outcomes

Background:

• Identifying patients at high risk for emergency department (ED) return visits is crucial for effective case management.
• Improving patient care and reducing healthcare utilization necessitates efficient patient identification systems.

Purpose of the Study:

• To develop and evaluate the Emergency Department Case Management Priority Score (EDCMPS), an electronic medical record (EMR)-based system for identifying high-risk ED patients.
• To assess the acceptability and performance of the EDCMPS among emergency department case managers (ED CMs).

Main Methods:

• Retrospective analysis comparing patient data pre- and post-EDCMPS implementation at Duke University Hospital ED.
• Development of the EDCMPS using LEAN and Plan-Do-Study-Act (PDSA) methodologies with ED CM input.
• Comparison of 7- and 30-day ED return and hospitalization rates; survey to evaluate CM satisfaction.

Main Results:

• The EDCMPS identified a lower percentage of high-risk patients (5.1%) compared to the manual method (10.3%), but with significantly higher predictive value for 7- and 30-day returns (e.g., 30-day OR=4.21 vs. 1.69).
• ED CMs broadly agreed the EDCMPS outperformed the manual method, particularly in organizing resources and referrals.
• Challenges identified include securing primary care follow-up, housing, and insurance applications.

Conclusions:

• The EDCMPS shows promise in improving ED case management efficiency and has strong frontline staff endorsement.
• The tool can pinpoint areas for patient support and potentially reduce ED revisits and healthcare utilization.
• The methodology provides a framework for similar implementations in other healthcare settings.