Thousands of patients across the country rely on hospital emergency departments for care every day. While most patients visit the ED for acute health needs such as broken bones or severe illness, some regularly misuse the ED to obtain prescriptions.
This type of misuse is partly fueled by the opioid epidemic. Between the rise in drug overdose patients and the misuse of the ED by individuals looking to obtain opioids, the nation's emergency departments have become the frontlines of the opioid crisis.
Beyond working to identify patients with opioid addiction, ED clinicians also have to identify patients with the threat of workplace violence. Knowing which patients may have had a history with workplace violence can be crucial to avoid situations of harm. However, due to interoperability challenges, not many EDs are equipped with technology systems that can identify ED misusers or patients that may pose a threat to staff.
At Torrance (Calif.) Memorial Medical Center, a 533-bed hospital, the ED registered approximately 90,000 visits in 2019. Some of these patients visited once in a year while others visited once a week. During a Dec. 4 webinar presented by Becker's Hospital Review and sponsored by Collective Medical, leaders discussed how hospitals can leverage a care collaboration platform to identify at-risk patients. The webinar featured two leaders from Torrance Memorial: David Presser, MD, the chair of the hospital’s "EDIE" committee; and Gina Sulmeyer, MD, the hospital's emergency medicine department chief.
The Collective Medical Platform
The Collective Medical platform, formally known as "EDIE" is licensed to hospitals to provide real-time notifications of patients who meet specific criteria. For example, if a patient visits an ED more than five times in 12 months, an alert could be sent.
After a patient registers at the hospital, the data is transferred to the Collective platform. Collective then screens the patient data against specific qualifiers to trigger a notification. It doesn't matter if a patient visits different hospital EDs; Collective Medical wholly collects data on patients and can communicate with all hospitals that use the platform—no matter existing operating systems being used.
If a patient is deemed at-risk, a notification is sent to the provider at the point of care. In some notifications, pre-designed care plans are also included.
"It helps us identify very vulnerable, high-risk patients whose needs are not being met in our fractured healthcare ecosystem," Dr. Presser said. "These are the folks that need our help the most, and these are probably the people where we need to pull our resources to address their needs. This isn't just from a financial perspective, but to also ensure the patients are getting safe, appropriate care."
The platform at Torrance Memorial Medical Center
After Torrance Memorial partnered with Collective Medical, a group of experts began integrating the platform’s notifications into its EHR.
"We brought together a team of system analysts, clinical informatics, clinical application analysts, integration architects and physician champions to work with Collective Medical [and] build the technical connections [needed for] this program," Dr. Sulmeyer said. "And now it works seamlessly within our electronic health record."
After implementation, the technology platform identified 26 patients at rising risk for ED overutilization, 22 high utilizers, 13 super utilizers and two extreme utilizers. Collective Medical defines extreme utilizers as patients who visit the ED more than 100 times in a year. While these patients hadn't all exclusively utilized Torrance Memorial's ED each time they sought emergency care, each had at least made a previous visit and had the potential to return to Torrance Memorial for future visits.
To make the data most useful, Torrance Memorial measured visits per month before and after patients underwent collaborative care plans. As of Aug. 4, just over 70 patients were issued care plans. More than half of the patients that were given care plans had reduced visits to the ED. Along with the reduction in ED overutilization, providers reported feeling safer at work.
Conclusion
In the coming months, Torrance Memorial plans to expand its use of the Collective platform. The hospital hopes to enhance its data collection and generate reports on patients by utilization, category and security threat. As a result, Torrance Memorial hopes to create a safer space for patients to receive care and physicians to provide treatment.
To learn more about Collective Medical, click here.
To view the webinar, click here.