Northwell Health's ED discharge program 'game changer' for vulnerable patients

Emergency department discharge is a critical point in the hospital healthcare process; communication is key in terms of making certain patients fully understand next steps to ensure optimal outcomes, Nancy Kwon, MD, vice chair of emergency medicine at Northwell Health, based in New Hyde Park, N.Y., told Becker's.

However, language barriers and other challenges informed by social determinants of health, combined with what Dr. Kwon referred to as the "chaotic nature of emergency departments" especially in the past few years, have created a breakdown in care once the ED discharge process is complete. 

The Emergency Department Discharge Center creates a "bridge between ED discharge and making sure patients, especially patients in vulnerable populations, follow through and get the care they need," said Dr. Kwon.

An expanded version of a discharge program Dr. Kwon started when she was a resident at Bellevue Hospital in New York City, Northwell Health's EDDC was launched at Long Island Jewish Medical Center in the city's Queens borough in May 2020, in the height of the COVID-19 crisis. 

The EDDC facilitates follow-up care during the discharge process by having coordinators visit patients at the bedside to help schedule primary care appointments and specialist referrals as soon as possible after discharge. 

Northwell Health does have an emergency medicine service line in place which is responsible for contacting discharged patients about making follow-up appointments. However, Dr. Kwon said, making those arrangements at the bedside, before the patient is discharged, makes it far more likely the patient will receive the recommended follow-up care which, in turn, increases the probability that patients will comply with other discharge instructions including taking prescribed medication as directed.

"For patients who are not discharged through the EDDC," Dr. Kwon added, "it's more of a catch-as-catch-can situation. We have to hope somebody is going to pick up the phone or initiate their own follow-up care."

According to an analysis of Northwell's EDDC published Feb. 13 by Cureus, "Vulnerable patients have difficulty arranging transitional care appointments due to poor health literacy, inadequate insurance, appointment availability and self-efficacy." 

The successfully reduced patient returns to the ED which, in turn, supports the continuum of care and has an increased positive effect on patient satisfaction.

The research indicated elderly and uninsured patients who were discharged through Northwell Health's EDDC received the most benefit from the program.

"Every emergency department should have a program like our EDDC," Dr. Kwon said. "It's a game changer. Our program provides a multidisciplinary approach, a more holistic approach, to the discharge process for patients who have difficulty navigating the healthcare system. The EDDC is a safety net for vulnerable patients. It provides a new structural and conceptual model for how patients can be discharged in a way that best supports their needs." 

Researchers collected data from the healthcare system's database from July 2020 through July 2021 to determine the effects of the EDDC's processes on same patient 72-hour ED returns and hospital admissions in the 30 days following discharge. Additionally, the analysis included Press Ganey's "likelihood to recommend ED" score as reported by EDDC patients. The EDDC patient cohort was compared to patients in the same hospital discharged without the assistance of the EDDC.

"It's not uncommon for patients in emergent settings to say the provider's discharge instructions are not clear," Dr. Kwon said. "The provider thinks they are being clear but, often, there isn't time to fully review the discharge instructions and language barriers get in the way." 

The result, she said, is that patients fail to engage in appropriate follow-up and they wind up right back at the ED soon after. "There's no question hospitals can do a better job at coordinating a patient's care after discharge. If they don't, they are risking poor outcomes and unnecessary return visits to the emergency department."

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