O0019: Redirecting Nonurgent Patients from the Pediatric Emergency Department to Their Pediatrician Office for a Same Day Visit - A Quality Improvement Initiative

Purpose/Objectives: There is a goal in patient care to optimize the value of every encounter. This includes providing efficient, high quality care in the appropriate setting for the patient’s presentation. Several initiatives have attempted to minimize nonurgent encounters within the Emergency Department (ED); and consequences of managing nonurgent complaints in the ED have been identified, including inefficiency, loss of connection with the Primary Care Provider (PCP), delay in care for other patients, and ED overcrowding. Previous work suggests that a solution may be found when increasing access to the PCP, and overcoming caregivers’ perceptions that only EDs can handle acute concerns. The purpose of the initiative was to redirect nonurgent patients who arrived in the ED to their PCP office for a same day visit, and the SMART AIM was to increase redirected patients from 0% of those eligible to at least 30% in 12 months.

Design/Methods: The setting is a tertiary care, pediatric medical system with over 100,000 annual ED visits at its two hospitals. It has 50 urgent, primary and subspecialty locations with over 1 million visits per year. This initiative was based at the Akron Children’s Main Campus ED and one on-campus PCP office. The initiative utilized Quality Improvement methodology. Patients were identified via a Best Practice Advisory within the Electronic Medical Record at the time of ED triage, offered redirect, then escorted to their PCP if they accepted. A balancing measure of the number of patients sent back to the ED was tracked to assess potential harm.

Results: The SMART AIM was achieved and sustained in the second half of data collection (Figure 1). In total, 216 patients were redirected, with zero untoward outcomes. The total encounter time for redirected patients was on average shorter than for those who refused redirect and remained in the ED. Health benefits were appreciated for redirected patients, including scheduling of overdue well-child checks while at the PCP, administration of flu and catch-up vaccines, and referrals made to pediatric subspecialists (Table 1).

Conclusion/Discussion: Through this initiative nonurgent patients were redirected efficiently from a high-level ED setting to a preferred level of care at their PCP office. Looking at the additional health benefits, this process is a valuable resource to patients and families, and supports the Patient Centered Medical Home. The balancing measure of no harm done to patients who accepted redirect reinforced the reliability of ED triage and provider medical screening exams. Families became familiar with the initiative, and when unable to schedule a PCP visit, some would present to the ED and request redirect. This initiative highlights the value of an efficient health care system, the PCP-patient relationship, and the continued need to improve access for our patients and their families.