strategies to effectively manage health care resources and in leading health care quality improvement

Jasmine Leakes

Reducing the number of unnecessary emergency room visits should be the goal of all working in the medical field. Working in a 100-bed nursing home with most patients diagnosed with Alzheimer’s Disease, it may be difficult to differentiate between what warrants an emergency room visit, versus what can be treated in the home/nursing facility setting. This can lead to many unnecessary and avoidable ER visits, overutilization of the emergency room, and costly bills to insurance and patients. Emergency department/room visits for nursing home residents lead to higher morbidity and mortality; therefore, inappropriate visits or potentially avoidable visits must be minimized (Zuniga, et al, 2022). ER visits not only include the risks of harm to the resident, but they also increase healthcare costs and use of resources when not necessary. ER visits are traditionally for acute care needs. When we are sending patients unnecessarily to an ED, we are blocking the chances for other serious cases that could arise. These visits burden the health care system. Selection, evaluation, and decision-making are very important factors to address prior to sending a patient to the emergency room.

To proactively address the issue above at hand, the facility should take steps to better understand its patient population and anticipate some of the reasons why these patients may report to the ER. It is important for the nursing and medical staff to identify and evaluate potentially high utilizers of the emergency room within the nursing home. Understanding why these patients are often sent to the ER can help to formulate a plan to reduce the number of times these residents are sent to the emergency department. Being a nursing home with patients primarily diagnosed with Alzheimer’s Disease, many caregivers can confuse symptoms of dementia/Alzheimer’s Disease with delirium. Delirium is a state in which a person is confused, disoriented, and not able to think or remember clearly. This usually starts suddenly and is often temporary and treatable. In contrast, dementia/Alzheimer’s symptoms typically develop slowly and become progressively worse. Proper education of the medical staff and caregivers is necessary to differentiate between what is a part of the chronic condition and what is acute. This can help to avoid ER visits when possible.

The use of the quality improvement tool titled INTERACT can also be useful in reducing emergency room visits. INTERACT was adopted and started in long-term care facilities to assist with reducing hospitalizations and high rates of ER visits. INTERACT stands for Interventions to Reduce Acute Care Transfers (Lamb, et al, 2011). This quality improvement tool focuses on preventing conditions from becoming severe enough to require emergency room visits, managing acute conditions in the nursing home, and improving advance care planning for residents for whom palliative or comfort care is appropriate (Lamb, et al, 2011). This is a tool that could be utilized in the nursing home setting to avoid unnecessary trips to the hospital.

In conclusion, preventive strategies focusing on high-quality ambulatory care might further reduce potentially inappropriate emergency room visits and admissions. To ensure that ER visits are utilized when necessary, evaluation protocols are essential to have in facility settings.

 

Lamb, G., Tappen, R., Diaz, S., Herndon, L., & Ouslander, J. G. (2011). Avoidability of Hospital Transfers of Nursing Home Residents: Perspectives of Frontline Staff. Journal of the American Geriatrics Society, 59(9), 1665–1672. https://doi.org/10.1111/j.1532-5415.2011.03556.x

Zúñiga, F., Gaertner, K., Weber-Schuh, S. K., Löw, B., Simon, M., & Müller, M. (2022). Inappropriate and potentially avoidable emergency department visits of Swiss nursing home residents and their resource use: a retrospective chart-review. BMC Geriatrics, 22(1), 659. https://doi.org/10.1