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Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions

  • Author(s): Carmel, Amanda S.
  • Steel, Peter
  • Tanouye, Robert
  • Novikov, Aleksey
  • Clark, Sunday
  • Sinha, Sanjai
  • Tung, Judy
  • et al.
Abstract

Introduction: Hospital admissions from the emergency department (ED) now account forapproximately 50% of all admissions. Some patients admitted from the ED may not requireinpatient care if outpatient care could be optimized. However, access to primary care especiallyimmediately after ED discharge is challenging. Studies have not addressed the extent to whichhospital admissions from the ED may be averted with access to rapid (next business day)primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol onavoidance of hospitalizations in a large, urban medical center.

Methods: We conducted a retrospective review of patients referred from the ED to primary care(Weill Cornell Internal Medicine Associates – WCIMA) through a rapid-access-to-primary-careprogram developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals wereclassified as either an avoided admission or not, and classifications were performed by bothemergency physician (EP) and internal medicine physician reviewers. We also collected outcomedata on rapid visit completion, ED revisits, hospitalizations and primary care engagement.

Results: EPs classified 26 (16%) of referrals for rapid primary care fol low-up as avoidedadmissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapidappointment. There were no differences in rates of ED revisits or subsequent hospitalizationsbetween those who attended the rapid follow-up and those who did not attend. Patients whoattended the rapid appointment were significantly more likely to attend at least one subsequentappointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8(18%), P=0.001].

Conclusion: A rapid-ED-to-primary-care-access program may allow EPs to avoid admittingpatients to the hospital without risking ED revisits or subsequent hospitalizations. This protocolhas the potential to save costs over time. A program such as this can also provide a safe andreliable ED discharge option that is also an effective mechanism for engaging patients in primarycare. [West J Emerg Med. 2017;18(5)870-877.]

 

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