Establish a special area for nonurgent ED patients

CMs should triage patients to proper level of care

The sign over your emergency department’s (ED) door may say "emergency," but the people who walk in may not necessarily be having one.

"The emergency department has become the gateway for everything, particularly among the population that is not insured. Hospitals are having to become creative in finding a different level of care for these patients," says Rick Wade, senior vice president for communication at the American Hospital Association.

A nonemergency clinic located near the ED and staffed by a nurse practitioner or physician assistant working under the supervision of a physician is one solution to the problem, he adds.

The clinic is part of the hospital but functions more like a physician’s office.

The cost for treating patients is lower because there’s a lower level of staffing than in the ED.

Once the patients are assessed, if their conditions are not urgent, they may be sent to the nonurgent clinic. That gives the case manager an opportunity to educate the patient to see a primary care physician if the same condition occurs in the future.

"The nonurgent clinic is particularly helpful on weekends and during peak times because nonurgent patients get care but they don’t create delays for people who truly have an emergency," he says.

"Case managers are a hospital’s primary line of defense in triaging patients to the right level of care. They not only understand the type of care the patient needs but they can communicate effectively and efficiently with the physician and the patient," says Mark Cameron, MBA, CHFP, health care consulting manager for Pershing Yoakley & Associates in Knoxville, TN, a health care consulting firm with offices throughout the South.

If ED case management works hand-in-hand with clinical staff in the nonurgent care area, it allows patients who do not have an emergency to be treated at more appropriate level of care by a nurse or a physician assistant and keeps the highly trained clinic staff available for a true emergency which can reduce resource costs, he explains.

Case managers should approach patients who come to the ED with nonurgent conditions and work with the treating clinician on developing a treatment plan that would keep the patient from coming back to the ED for routine matters, connecting them to physician offices, home health services, and other resources, he adds.

"The key is on medical screening and triage. If there is a question, the decision needs to be made by the physician or physician assistant in charge," he says.

Cameron suggests that hospitals create a checklist of conditions that could qualify patients for the nonurgent care area. If there is any uncertainty, the case manager should check with the physician or physician assistant.

"Having protocols in place allows the emergency department triage staff to go through symptoms and chief complaints and identify a lot of nonurgent patients in the process," says Cameron, cautioning that in some cases, the case managers should alert the physician to rule out that there are no serious underlying causes for the symptoms.