A Collaborative Approach to Emergency Department Case Management
by Stacey Hauser

Each year, millions of people visit emergency departments across the country. For most, the visit is a result of a serious illness, injury or accident. But recent trends show that many people are utilizing emergency departments for non-emergent issues. Increasingly, emergency departments are becoming a primary care stop for non-emergent issues, which taxes an already burdened system — one equipped to treat someone’s symptoms, not their overall and ongoing health issues.

In Lincoln, Neb., an innovative and unique approach to this issue has been developed. Lincoln E.D. Connections, a collaborative case management model between two independently owned hospitals — BryanLGH Medical Center and Saint Elizabeth Regional Medical Center — was implemented to improve healthcare access and outcomes for patients who present to emergency departments, some for non-emergent reasons and others because of lack of insurance or a medical home. The goal of the project is to connect patients to a medical home and other community resources to help improve their lives. The three-year project is being funded by Community Health Endowment in Lincoln. Together, an RN Case Manager and a community based Case Manager coordinate the program.

What sets the project apart from other hospital case management programs is that that staff work with patients away from the hospitals while more traditional care managers work with the patient while they are in the hospital to access resources upon discharge. Lincoln E.D. Connections initially may see a patient in the emergency department to get them enrolled, but subsequent visits usually occur in the patient’s home or at his or her doctor’s office. Project staff encourages patients to follow up with their primary care physicians for non-emergent issues instead of coming to the ED. However, staff never tells patients they cannot go to the emergency department; if they feel that’s where they need to go, staff supports that decision.

Lincoln E.D. Connections saw its first patient in October 2005. By October 2006, 82 patients were enrolled. Project staff saw amazing results in the first year:

• 63 percent reduction in emergency department visits after the patients were enrolled and connected to a medical home and to other resources.
• 64 percent cost reduction.
• 100 percent of the patients enrolled were connected to primary care physicians.
• 87 percent made at least their first visit.
• 64 percent of enrolled patients increased their health functioning.
• 76 percent identified an increase in knowledge about healthcare choices as a result of case management and project participation.
• 100 percent of patients without access to regular prescription medications (43 of the 82) were enrolled in some type of medication assistance program.

We attribute the success of the project to ongoing case management with patients, collaboration between the two hospitals and community agencies, and ongoing contact with emergency department staff and hospital social workers.