Use of Care Guides to Reduce Emergency Department Visits by High-Frequency Utilizers

• Published in: Journal of emergency nursing 2023-11, Vol.49 (6), p.863-869
• Main Authors: Schoolmeester, Amanda, Keiser, Megan
• Format: Article
• Language: English
• Subjects: Case management; Emergency department; Emergency medical care; Emergency nurse; Emergency services; Health care; Health care utilization; Health services; Health services utilization; Intervention; Length of stay; Managers; Mental health care; Nurse managers; Nurses; Overcrowding; Patients; Physicians; Quality management; Social work; Social worker; Social workers; Visits
• ISSN: 0099-1767; 1527-2966
• DOI: 10.1016/j.jen.2023.07.007

High-frequency utilizers are defined as patients who present 10 or more times to the emergency department in a rolling 12-month period. High-frequency utilizers contribute to emergency department overcrowding and misuse of resources, and reduce the efficiency of health care systems. Care guides have proven to be an effective tool in reducing high-frequency utilizers. The objective of this quality improvement project was to determine if implementing a care guide for high-frequency utilizers to address the core needs of the patient and facilitate resources through case management consultation decreases the number of visits and the cost of unreimbursed care to the emergency department from high-frequency utilizers. We implemented care guides for high-frequency utilizers in September 2014. Prior to initiating the care guides, we educated the physicians, nurses, case managers, and social workers in the emergency department. Following the implementation of the care guides, there was a steady decline in the number of high-frequency utilizers (338 in 2013–68 in 2021), the number of total emergency department visits by high-frequency utilizers (6025 in 2013–1033 in 2021), and unreimbursed care ($2,068,063 in 2013–$589,298 in 2021). The use of care guides was a successful strategy in reducing emergency department visits and the cost of unreimbursed care by high-frequency utilizers by providing them with the education and resources they require to receive health care services in appropriate settings.