Faced with a medical concern, when should you head to the emergency room and when is your neighborhood medical center the better choice, even after regular business hours?
That’s the question Pacific Medical Centers’ Federal Way staff posed to patients in an effort to reduce unnecessary emergency department use. The results have been significant.
The issue
Emergency department use has increased sharply in recent years, straining the emergency medical system and causing considerable waits for patients. The causes of that jump include both challenges in finding a primary care physician and shifting societal attitudes – we expect access to things right away, says Dr. Rick Ludwig, Pacific Medical Centers’ Medical Director of U.S. Family Health Plan.
“It’s really a community issue – and it’s a national issue – that has significant ramifications,” he says.
Discussions about emergency department overuse typically focus on frequent users, however about 75 per cent of patients visiting the ER do so only once or twice a year. If non-emergent visits were redirected to more appropriate medical caregivers, ER staff and resources could better handle the emergencies, explains Dr. Ludwig.
Common issues taking patients to the ER often unnecessarily include upper respiratory infections, urinary tract infections, headaches and mild dizziness. But sometimes simply talking to a medical professional can alleviate concerns.
“Our project was really focused on educating patients that the PacMed clinic is accessible to them 24/7. We have people here who can take their calls, answer their questions and see them if needed,” Dr. Ludwig says.
The message
PacMed’s message to patients is that staff are available. If an after-hours incident occurs for a patient, an initial call lets them talk to someone about their concern. That discussion can help determine if the issue can be dealt with at the clinic, if it can wait until the next day, or if it might not be a concern at all, Dr. Ludwig says, emphasizing that if patients believe their condition is urgent, they should call 9-1-1 and immediately attend the emergency department.
The pilot project has shown a reduction in nearby emergency department use of about 5 per cent from 2016 to 2017, Dr. Ludwig says.
And patient benefits reach beyond time savings. When attending their PacMed clinic, patients can work with staff who know them and who have convenient access to their records and information.
“We want to give people the best possible experience,” Dr. Ludwig says.
The solution
The first step was raising awareness among patients and reinforcing the message. Upon check-in every patient received a business card that was printed with the usual information on the front, but on the back was a reminder about the clinic’s after-hours accessibility.
At check-out, the patient was reminded verbally of the after-hours access, and a printed message was included on their record of visit. For those in the retired military community, who the clinic was particularly trying to reach, a refrigerator magnet with the same messaging was mailed out.
What clinic staff learned surprised them.
“We were surprised at how many people didn’t know that they could call us after hours and access our services,” Dr. Ludwig says. “That made us even more vigilant to let our patients know and that’s the information we’re taking to our other clinics.”
Raising awareness about PacMed’s services was also important. For example, minor lacerations can be cleaned and stitched in the clinic, and if someone needs rehydrating IV fluids after an illness, they can do that too.
“We want to have the opportunity to talk to the patients and say, we can take care of you,” Dr. Ludwig says.
