Case Management Reduces Length of Stay, Charges, and Testing in Emergency Department Frequent Users

Abstract

IntroductionCase management is an effective, short-term means to reduce emergency department (ED) visits in frequent users of the ED. This study sought to determine the effectiveness of case management on frequent ED users, in terms of reducing ED and hospital length of stay (LOS), accrued costs, and utilization of diagnostic tests.MethodsThe study consisted of a retrospective chart review of ED and inpatient visits in our hospital’s ED case management program, comparing patient visits made in the one year prior to enrollment in the program, to the visits made in the one year after enrollment in the program. We examined the LOS, use of diagnostic testing, and monetary charges incurred by these patients one year prior and one year after enrollment into case management.ResultsThe study consisted of 158 patients in case management. Comparing the one year prior to enrollment to the one year after enrollment, ED visits decreased by 49%, inpatient admissions decreased by 39%, the use of computed tomography imaging decreased 41%, the use of ultrasound imaging decreased 52%, and the use of radiographs decreased 38%. LOS in the ED and for inpatient admissions decreased by 39%, reducing total LOS for these patients by 178 days. ED and hospital charges incurred by these patients decreased by 5.8 million dollars, a 41% reduction. All differences were statistically significant.ConclusionCase management for frequent users of the ED is an effective method to reduce patient visits, the use of diagnostic testing, length of stay, and cost within our institution.

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“…[ 22 ] Whenever the peak of admissions is reached, one of the essential requirements is the availability of enough case managers and housekeepers to ensure a rapid turnover of beds. [ 23 ] In this situation, it is advisable to have additional security staff to ensure preventing visitors from entering the hospital and also to ensure social distancing and no in-person socialization among sitters on the pediatrics floors.…”

Tracing frequent users of regional care services using emergency medical services data: a networked approach

“…Subsequently, the appropriate answers to their needs, and consequently reducing the visits to ED and ambulance transports may be achieved. These solutions range from case management [4][5][6] to individual care plans, [7][8][9] and facilitated contacts with healthcare providers. 10 However, to be able to offer and consider such a form of advance care planning for apparently frail patients, they first need to be identified.…”

The Characteristics and Effectiveness of Interventions for Frequent Emergency Department Utilizing Patients With Chronic Noncancer Pain: A Systematic Review

“…These findings are in line with the available evidence from studies of the general frequent ED utilizer population. [34][35][36][37][38] The intervention modalities seen in the included studies were grouped into four distinct categories: EMR alerts (regarding patient enrollment status, existence of a care plan), primary care contact and referral, individualized care plans, and opioid policies. Contrary to previous research suggesting that singularly focused interventions yielded better patient outcomes, 39,40 large-scale (i.e., >60%) and statistically significant reductions in ED visit frequency were more common in the eight multifaceted interventions in this study compared to those using a single modality.…”