04/18/23 1

Fitting the Pieces TogetherUtilizing a Hospitalist in the ED to

Reduce Admissions

Presented by:

Patty Williamson, CFO

Isidoros Vardaros, M.D.

04/18/23 2

Quincy Medical Group

• Multi-specialty medical group serving Quincy, IL and surrounding tri-state area

• 100 Physicians, 135 Total Providers

• All primary care physicians are Level 3 NCQA PCMH certified

• Blessing Hospital is independent and is not part of the UnityPoint system

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Strategy = Triple Aim

• QMG’s strategic plan is the Triple Aim

• Focused on developing change agents within the organization

• 3 physician led committees– Quality – 5 physician led teams around diabetes,

hypertension, COPD, osteoporosis, and CHF– Patient Satisfaction – providing transparent Press Ganey

results with a goal of achieving the 90th percentile– Total Cost of Care – focused on reducing hospital

admissions

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10 Initiatives

1. After Hours Nurse Triage Phone Service via UnityPoint2. Home Health Care via UnityPoint at Home3. Expand ACC and/or Primary Care hours4. Expand Infusion Center and Imaging hours5. Hospitalist assessing patient in Emergency Room6. Use Nurse Care Coordinator Model – BCBS Int. Medical

Home7. Discharge Nurses to ensure good transition to outpatient8. Nursing Home NP model of care9. Patient education about preferred access points10. Educate physicians on preferred ER referral process

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Logistics of the Practice

Located in the ER:

• Direct access to patient care before final admission or discharge is determined by ER physician

• Compare labs/notes from QMG’s record and hospital’s record to assess patient’s change in medical status

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Logistics of the Practice

Service for QMG Patients:

• Exclusively for QMG patients

• Direct patient toward the correct admitting physician or discharge to the primary care provider

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Logistics of the Practice

Ages Served:

• Discharge patients as young as 6 months old with appropriate follow up

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Logistics of the Practice

Identifying Patients:

• Blessing Hospital provides QMG census report

• Able to view QMG patients that are currently in the ED under “ED Status”

• Directly assess patients once the ER physician has completed their initial encounter

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U-Turn to Appropriate Care

Assess Patients with Status of:

• Inpatient Admission

• Observation Admission

• 30 Day Re-admission

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U-Turn to Appropriate Care

• Observation Status: Does not meet inpatient criteria

• 30 Day Re-admission: Returns to ED less than 30 days from previous discharge

• Goal is to treat “observation” or “30 day re-admission” patients in the outpatient setting when appropriate

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Improving Patient Care by…

Educating Patients on Preferred Access Points:

• Scheduling appointments with specialists if warranted

• Ordering future lab studies or investigative procedure as an outpatient

• Scheduling PT / OT / Rehab / Home Health Care when appropriate

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Improving Patient Care by…

Redirecting Patients to Primary Care:

• Scheduling “same day” or “next day” appointments with PCP or specialist

• Leaving available time slots for future appointments

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Improving Patient Care by…

Scheduling Next Day Appointments:

• QMG schedule hotline

• Available during regular office hours to schedule appointments

• Available on-call during hospitalist work hours

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Improving Patient Care by…

Care Coordination with Primary Care Physician:

• Work closely with ED physician and relate any current outpatient labs / investigative procedures

• Document “ED encounter” in hospital’s record

• Document note in QMG’s record

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Improving Patient Care by…

Directly Admitting to Nursing Homes:

• Directly admit to NH when clinically indicated

• Communicate with ED physician and PCP if admission is appropriate

• Document initial encounter and provide initial NH admitting orders

• PCP to follow thereafter

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Improving Patient Care by…

Ordering Home Health, PT, OT, Etc.:

• Certain encounters have required new or continued orders for physical or occupational therapy

• Several encounters have given the opportunity for home health care referral

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Barriers Encountered

• Initial resistance from hospital

• Heavy volume days

• Time delay for patients to show on census

• Unknown PCP status

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Success Stories

• 88 year old female who is homebound

• 56 year old male with intractable back pain

• The “chest pain rule out” patient

• Educating new parents on appropriate ED visits

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Results

• Acceptance by Emergency Department physicians

• QMG physician feedback

• Data

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Results

• 145 patients have been assessed and not admitted– 74 patients discharged that would have been

admitted– 71 patients assisted in discharge

• 20 average avoided admissions per month• Average length of stay at Blessing Hospital is

3.6 days• Average estimated cost savings of $2,160,000

annually

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Questions?