Intervention Title: Improving Emergency Department (ED) Flow With a Care Management Unit (CMU) – Grady Health System, Atlanta, Ga.
Goal: Improve patients' access to primary care, as well as decrease relapse rates, admission to telemetry beds, short-stay admissions and cost of care.
Innovation: Staff created a seven-bed Care Management Unit with four dedicated nurses and four dedicated case managers to reduce the number of boarders.
Result: In the first year, 1,200 patients were treated in the CMU. Of those patients, 85 percent went home following treatment and only 15 percent were admitted. Traditionally, all of the CMU patients would have been admitted and required to wait for a bed. Since the CMU was created, the ED has experienced decreases in the number of short stay admissions, admissions to telemetry beds, relapse rates and cost of care. It has also experienced an increase in patient satisfaction.
Grady Health System
80 Jesse Hill Jr. Dr., SE
Atlanta, GA 30303
P: (404) 616-1000
From the C-Suite:“On any given day, 10 to 12 patients go through the unit. Not only do these patients get proper medical treatment and avoid being admitted, but they get access to needed primary care and follow-up care coordination. Anytime you can move patients into a more effective model of care while at the same time improving patient flow in the ED, that's a win-win in my book.”
Leon L. Haley, Jr., M.D., M.H.S.A., F.A.C.E.P.Chief of Emergency Medicine
Grady Health System is a licensed, 1,047-bed, 700-operational-bed facility located in Atlanta, Ga. It includes 88 acute ED beds as well as seven CMU beds.
Clinical areas affected:
- Emergency department
- Emergency department staff
The CMU began with a one-year pilot program to get the unit fully up and running.
Leon L. Haley, Jr., M.D., M.H.S.A., F.A.C.E.P.Chief of Emergency MedicineDeputy Senior Vice PresidentP: (404) 616-6419Leon_Haley@emoryhealthcare.org
Innovation implementation: Busy emergency departments often suffer from major bottlenecks in both their throughput and output stages. This leaves patients in the ED waiting for inpatient beds, creates long patient throughput times, increases ambulance diversions and contributes to increasing rates of patients who leave without being seen. In terms of output, many patients have to wait a long time following treatment in the ED before being admitted to the hospital. Working to address these bottlenecks, Grady Health System undertook an initiative to improve ED patient flow for patients with specific diagnoses. It created the CMU, which treats patients with well-defined outcomes. Diagnoses treated include low- to intermediate-risk chest pain (53 percent of patients), heart failure (11 percent), asthma (33 percent) and hyperglycemia (three percent). A case manager serves as the link between acute care, follow-up care and primary care through disease-specific education, direct phone follow-up (after 48-72 hours) and management of the patient's history in a database. The CMU allows the patients to be treated without being admitted and exposes them to a case manager who coordinates their follow-up care and links them with primary care.
Advice and lessons learned:
- Well-defined outcomes are a must.
- The unit needs to be ED-based
- Size matters
Following their stay in the CMU, 85 percent of patients are discharged home and 15 percent are admitted. The average length of stay (ALOS) in the CMU is 18 hours and 58 minutes. For congestive heart failure, the ALOS is 19 hours and 49 minutes. Additionally, the CMU has improved access to primary care. Data collected indicate that all patients were given an appointment within 48 to 72 hours of their CMU visit. For the diabetes clinic, 41 percent of patients kept their appointment; for the diabetes support and education programs, 44 percent kept their appointment; and for the medical clinic, 44 percent kept their appointment.