the harris county hospital district program pete dancy, fache associate administrator ben taub...
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The Harris County Hospital District The Harris County Hospital District
ProgramProgram
Pete Dancy, FACHEPete Dancy, FACHEAssociate AdministratorAssociate Administrator
Ben Taub General HospitalBen Taub General HospitalHouston, TexasHouston, Texas
April 3, 2008April 3, 2008
Ben Taub General Hospital • Level 1 Trauma Center
• Over 89,000 EC Visits FY 06
Lyndon B. Johnson General Hospital• Level 3 Trauma Center
• Over 64,000 EC Visits FY 06
Harris County Hospital District (HCHD) Harris County Hospital District (HCHD) Emergency CentersEmergency Centers
EC CompressionEC Compression 4/1/2008 (Ben Taub) EC diversion was implemented @ 20:32 at the
request of ANM and with the approval of medicine staff. They remain open to trauma.
EC is at 144% saturation. All shock rooms are currently full with two patients waiting in the hallway on stretchers. Holding has a total of forty patients most of which are still being evaluated. All admits have beds and are being transferred without delay.
Launched August 2006
Major Objectives Shift Primary Care Related Visits to Most Appropriate
Settings
Provide the Right Level of Care at the Right Place at the Right Time
Reduce EC Overcrowding
Provide Better EC Access for True Emergencies
Teach Patients About Good Use of EC Resources
Find Patients a Medical Home for Primary Care
RightCareRightCare
Patient Presents to EC
Triaged by an EC Nurse Using a 5 Level Triage System Level 1 – cardiac arrest or immediate life-threatening
Level 2 – significant trauma or manifest unstable physiology
Level 3 – Require 3 or more resources (i.e. lab, x-rays, consultations, etc.) LARGEST TRIAGE GROUP
Level 4 or 5 (lower acuity) - Require none or minimal resources
RightCare ProcessRightCare Process
Nurse Practitioners/Physician Assistants – screen Level 4 and 5 patients Emergent – treated in EC
Non-emergent patients are referred to Access/Financial Counselors/Cashiers
Patients provided service options Treat in EC
Treat in Urgent Care
Refer to a Community Clinic or HCHD Community Health Center
• If necessary, refer patient to Eligibility Office to Establish a Primary Care Medical Home
RightCare Process (Continued)RightCare Process (Continued)
AppropriatePatients sent
To Medical Screen
Is There a Medical
Emergency?
YES
NO
Patient is treatedIn Emergency
Center
RightCare EC ProcessRightCare EC Process
RightCare Program Fee StructureRightCare Program Fee Structure
Person 1
$150 deposit Based OnEligibility
$80
EC CareUrgent Care
Clinic Prescriptions
0
200
400
600
800
1000
1200
1400
08/06 10/06 12/06 02/07 04/07 06/07
NP/PA Screened
Non-Emergent (AccessCounselor Referred)
Screened and Non-Emergent PatientsScreened and Non-Emergent Patients
Patient Referrals to Primary Care Settings
Lack of Established Eligibility
Capacity Limitations
Nurse Practitioners (Ben Taub)
Increase Utilization (UCC)
Decrease Patient Wait Times
Decrease Left Before Treatment
Frequent Fliers
RightCare ChallengesRightCare Challenges
Increase Case Management Involvement for EC High Users (4+ Visits Month)
EC Clinical Case Managers, Social Work Case Managers, EC Nursing
Establish a process to provide prompt notification of high utilizers upon arrival
Minimize EC waiting times by quickly identifying patient issues
Navigate patients to appropriate community health program
RightCare Next StepsRightCare Next Steps
The Right Care Program has not denied medical care to any patient experiencing a medical emergency
Education
Continue Patient Education About Medical Home
Target Level 3 Patients Largest Triage Group, Use the Most Resources, Highest Left Before Treatment Group
RightCare Next StepsRightCare Next Steps
“Continuing to communicate the message to the
community that emergency centers are not places
where they should go for primary care is important.
We have options for our patients, and RightCare gives it
to them.”
Dr. Thomas Granchi, Medical Director, Ginni and Richard Mithoff Trauma and Emergency Center, Ben Taub General Hospital, August 2007
Physician PerspectivePhysician Perspective
“I knew I wanted to be seen, but they told me my wait in
the emergency center might be long, so I opted for the
Urgent Care Center. The service was quick, and they
also told me how I could go to a community clinic for
follow-up.”
Urgent Care Center Patient, Ben Taub General Hospital, August 2007
Patient PerspectivePatient Perspective
QuestionQuestionss