Her absolute neutrophil count (ANC) was less than 0.1 cells/µL. Neutropenic fever is considered an oncologic

emergency because it indicates infection in the presence of a depressed immune system.

Johnston County Emergency Department: Decreasing Non-Emergent & Repeat ED Visits

BACKGROUND

METHODS

Grace Lea Dumayas1, OD, FAAO, Erin Franzen2, Tonisha Lashley3, Catherine Macek3, Tasha Rose4, BSN, RN, PCCN, RIPHI Champion: Christina Leonard, RN, MSN, FNP-bc, CNL

1 MPH Candidate, Gillings School of Global Public Health, 2OTS Candidate, Department of Occupational Therapy, 3ABSN Candidate, Department of Nursing, 4MSN Candidate, Department of Nursing

REFERENCES

Community Health Needs Assessment and Implementation Strategy (2016). Johnston Health. Retrieved from http://johnstonhealth.org/wp-content/uploads/2016/06/2016-CHNAFinal-Johnston-Health.pdf

Johnston Health is a 199 bed non-profit hospital affiliated with UNC Health Care. The Emergency Department (ED) treats approximately 120 patients each day. Johnston Health serves a rural population in Smithfield, North Carolina. Johnston County’s rate of uninsured citizens is above the state average. There is a lower ratio of primary care physicians to the total population and a higher amount of preventable hospital stays. Key stakeholders in Johnston’s ED identified concern for the amount of high risk patients with return visits to the ED. While there are existing community resources, ED nurses expressed a need for greater transparency of available resources at the point of patient contact.

ACKNOWLEDGEMENT

INTERVENTION

Interviews were conducted with Johnston County Emergency Department stakeholders including: ED administrative director, Johnston County Home Health Care coordinator. charge nurse, social worker, ED physician, clinical coordinator, Mental Health staff member and a community paramedic. Data was collected and analyzed regarding chief complaints of returning users of the ED. Current ED resources were examined including community resource handouts and processes for referrals to community resources as well as home health care. Data collected was analyzed and key stakeholders were consulted regarding the results and the plan to address the major concerns.

Keywords: Home Health Care, Community Resources, ED Revisits, Inter-professional, Multi-disciplinary

INITIAL DATA

The population of Johnston County:• 18.7% of population without health insurance

(US=17.7%) • 17.5% of adults report that they cannot afford a

doctor visit (US=15.6%)• Growing need to serve the elderly population• Lack of access to transportation for low income

and rural residents

ED DataScope of the problem:Between 04/01/2017 and 10/26/2017, 86 patients were readmitted to the ED more than 5 times and averaging more than 11 times between 04/01/2017-10/26/2017.

Our team analyzed patient visit and return visit data for December 2017 and January 2018.

Month Number of ED Visits

Number of Return Visits

December 2017 753 591January 2018 540 431

“Why do patients use the ED for non-emergent care?”

• Lack of primary care providers with immediate availability to address concerns

• Inability to afford copay for other doctors’ visits or services

• Challenges with transportation to regular doctors’ visits or follow-ups

• Low health literacy• Lack of education on managing their condition, taking

medications and other options for care• Large population of undocumented persons

RESULTS

CONCLUSION

OBJECTIVE:Decrease ED utilization for same complaints and non-emergent medical problems by increasing referrals to home health and connecting patients with community resources.

DELIVERABLES:• Created 14 laminate flow charts with corresponding

color-matched patient hand-outs to assist nurses in connecting patients with community resources specific to needs and chief complaint.

• A home health checklist was printed on the back of the flowchart to assist staff in identifying patients who would benefit from home health resources and in completing the referral.

• Conducted training and education 24 ED staff on the intervention and asked to provide feedback during the pilot period.

• Laminates and handouts provided in the following key locations: Triage, Nurse Station, Fast Track, ”The Pit”, and Registration.

• Head nurse informed personnel during their morning huddle on intervention and available resources and to provide feedback.

Since intervention was just launched, our results are pending. We will continue to monitor the number of times ED staff utilize the intervention and implement their input after a one week trial period. Their Share Point website will be tailored to match the flowchart and gain access to the resources in just a few clicks. In addition, the hard copy will remain in the key areas as mentioned above, giving ED staff two ways to access our intervention.

Our anticipated outcomes:

• Decrease re-admission of non-emergent ED patients once appropriate resources are matched with their needs

• Increase staff awareness on home health care capabilities and usage

• Increase follow up care and coordination for discharged patients for less ED dependency

• Increase usage of available resources in the community for less ED dependency

• Address health literacy better through community resource referrals

Figure 1. Ranks the top 10 complaints by ED patients from the most to the least.

Figure 2. Flowchart and resources provided for intervention.

Table 1. Number of visits and return visits to the ED for December 2017 and January 2018.

• This project was funded by the Rural Inter-Professional Health Initiative

• Special thanks to Mary Lynn Smith, Beth Walker, Lisa Peacock, and Kathleen McKinnon for coordination and assistance throughout the project.

• ED staff for their input and feedback on intervention.

PatientsCheckinginto

ED

REFERtoPCPforpatientswithoutInsurance

NEEDSFOLLOWUPCAREbyPCP

SOCIALSERVICES

REFERtoDentalOffices

REFERFor:BehavioralHealthChildServicesCrisisServicesDomesticViolenceSubstanceAbuseOTHER

REFERtoPCPforpatientswithInsurance

REFERFor:ClothingFoodAssistanceHousingJobTrainingPestControlTransportationOTHER

REFERtoPCPacceptingMedicaid/NCHealthChoice

SPECIALTY

REFERtoPharmacyResources

REFERtoHomeHealthCare(seereferralchecklistonthebackofflowchart)