When patients show up in the emergency department for non-emergent issues, Renee Perez, community health outreach coordinator/emergency department navigator for Carondelet Health Network in Tucson, AZ, coordinates a follow-up appointment with a primary care provider.
Patients who use the emergency department for primary care tend to fall into one of three categories: patients who are uninsured and don’t have a primary care provider, those who are insured but don’t have a primary care provider, and those who have a primary care provider but can’t get in to see him or her, Perez says.
"The patients get the care they need in the emergency department, then I coordinate the follow-up appointment with a primary care provider. Some patients need follow up the next day; others can wait longer. I try to get all the patients who are referred to me set up in a medical home if they don’t already have one," Perez says.
If patients have a primary care provider but can’t get an appointment, Perez contacts the provider office and asks them to work the patient in. If patients still can’t get an appointment, she refers them to walk-in clinics for treatment while they wait for a slot at their regular physician office.
Perez gets between 50 and 100 referrals a month from emergency department physicians and case managers. Whenever possible, she meets with the patients while they are still in the emergency department. Otherwise, she contacts them by telephone and helps them get established with a primary care provider in a convenient location.
After she refers people to a clinic, Perez calls the primary care clinic to find out if the patient went to his or her appointment and documents it in the medical record.
Many people who frequently use the emergency department are uninsured, says Donna Zazworsky, RN, MS, CCM, FAAN, vice president, Community Health and Continuum Care for Carondelet Health Network. "The role of our navigators is to help patients learn to navigate the healthcare systems and to identify community resources," Zazworsky says.
The navigators are not clinicians and are from the varying cultures that represent the people they serve, making it easier to establish rapport with the patients. They assess the patients for psychosocial needs and can help them sign up for Medicaid, food stamps, energy assistance programs, Social Security disability, or other assistance programs.
If they are uninsured, Perez helps them find a medical home at a federally qualified health center. "Most of these patients do not realize that there are other resources out there where they can receive care at a reduced rate or for no cost," she says.
Perez educates patients on seeking care in an appropriate setting. "I tell them I can get them set up at a low-cost clinic where the fee depends on the family size and family income. I explain why it’s better to have your own primary care doctor than to come to the emergency department when it’s not an emergency."
If patients continue to come to the emergency department for primary care, Perez meets with them again and arranges another appointment in a medical home.
"There are people that keep coming back for primary care issues. They tell me they forgot the appointment or they didn’t have the money. I keep working with them in hopes that they eventually understand," she says.