The Harris County Hospital District The Harris County Hospital District

ProgramProgram

Pete Dancy, FACHEPete Dancy, FACHEAssociate AdministratorAssociate Administrator

Ben Taub General HospitalBen Taub General HospitalHouston, TexasHouston, Texas

April 3, 2008April 3, 2008

Ben Taub General Hospital • Level 1 Trauma Center

• Over 89,000 EC Visits FY 06

Lyndon B. Johnson General Hospital• Level 3 Trauma Center

• Over 64,000 EC Visits FY 06

Harris County Hospital District (HCHD) Harris County Hospital District (HCHD) Emergency CentersEmergency Centers

EC CompressionEC Compression 4/1/2008 (Ben Taub) EC diversion was implemented @ 20:32 at the

request of ANM and with the approval of medicine staff. They remain open to trauma.

EC is at 144% saturation. All shock rooms are currently full with two patients waiting in the hallway on stretchers. Holding has a total of forty patients most of which are still being evaluated. All admits have beds and are being transferred without delay.

Launched August 2006

Major Objectives Shift Primary Care Related Visits to Most Appropriate

Settings

Provide the Right Level of Care at the Right Place at the Right Time

Reduce EC Overcrowding

Provide Better EC Access for True Emergencies

Teach Patients About Good Use of EC Resources

Find Patients a Medical Home for Primary Care

RightCareRightCare

Patient Presents to EC

Triaged by an EC Nurse Using a 5 Level Triage System Level 1 – cardiac arrest or immediate life-threatening

Level 2 – significant trauma or manifest unstable physiology

Level 3 – Require 3 or more resources (i.e. lab, x-rays, consultations, etc.) LARGEST TRIAGE GROUP

Level 4 or 5 (lower acuity) - Require none or minimal resources

RightCare ProcessRightCare Process

Nurse Practitioners/Physician Assistants – screen Level 4 and 5 patients Emergent – treated in EC

Non-emergent patients are referred to Access/Financial Counselors/Cashiers

Patients provided service options Treat in EC

Treat in Urgent Care

Refer to a Community Clinic or HCHD Community Health Center

• If necessary, refer patient to Eligibility Office to Establish a Primary Care Medical Home

RightCare Process (Continued)RightCare Process (Continued)

AppropriatePatients sent

To Medical Screen

Is There a Medical

Emergency?

YES

NO

Patient is treatedIn Emergency

Center

RightCare EC ProcessRightCare EC Process

RightCare Program Fee StructureRightCare Program Fee Structure

Person 1

$150 deposit Based OnEligibility

$80

EC CareUrgent Care

Clinic Prescriptions

0

200

400

600

800

1000

1200

1400

08/06 10/06 12/06 02/07 04/07 06/07

NP/PA Screened

Non-Emergent (AccessCounselor Referred)

Screened and Non-Emergent PatientsScreened and Non-Emergent Patients

Patient Referrals to Primary Care Settings

Lack of Established Eligibility

Capacity Limitations

Nurse Practitioners (Ben Taub)

Increase Utilization (UCC)

Decrease Patient Wait Times

Decrease Left Before Treatment

Frequent Fliers

RightCare ChallengesRightCare Challenges

Increase Case Management Involvement for EC High Users (4+ Visits Month)

EC Clinical Case Managers, Social Work Case Managers, EC Nursing

Establish a process to provide prompt notification of high utilizers upon arrival

Minimize EC waiting times by quickly identifying patient issues

Navigate patients to appropriate community health program

RightCare Next StepsRightCare Next Steps

The Right Care Program has not denied medical care to any patient experiencing a medical emergency

Education

Continue Patient Education About Medical Home

Target Level 3 Patients Largest Triage Group, Use the Most Resources, Highest Left Before Treatment Group

RightCare Next StepsRightCare Next Steps

“Continuing to communicate the message to the

community that emergency centers are not places

where they should go for primary care is important.

We have options for our patients, and RightCare gives it

to them.”

Dr. Thomas Granchi, Medical Director, Ginni and Richard Mithoff Trauma and Emergency Center, Ben Taub General Hospital, August 2007

Physician PerspectivePhysician Perspective

“I knew I wanted to be seen, but they told me my wait in

the emergency center might be long, so I opted for the

Urgent Care Center. The service was quick, and they

also told me how I could go to a community clinic for

follow-up.”

Urgent Care Center Patient, Ben Taub General Hospital, August 2007

Patient PerspectivePatient Perspective

QuestionQuestionss