Caregiver Online Scheduling Model: An ED Referral Discharge to Primary Care Process within an Urban Hospital

Background: In an effort to control health care costs in this era of health care reform, emergency departments are compelled to create coordinated systems to better manage the utilization of their emergency departments, hospitals, clinics and outpatient services.

Objective: To describe elements of best practice and assess the results of an emergency department's discharge referral model that provides patients with follow up appointments to a primary care clinic prior to the patient leaving an urban hospital.

Methods: Upon discharge, patients became part of an ongoing cohort when emergency department schedulers used the online scheduling system to make follow-up appointments. Patients' utilization of the system was tracked both one year before their online scheduling experience and then every time afterwards.

Results: Patients being discharged from the emergency department had clinic appointments scheduled for follow up via an internal online scheduling process of which 80.6% (N = 522) were established patients within the health system and 19.4% (N = 126) were new patients. Although the established patients had a slightly higher show rate at 49.8% for their clinic appointments, the new patients only had a slightly lower show rate at 49.2%. According to the literature, both of these percentages are considered fairly high for ED discharge to primary care follow up appointments.

In eight months, ED utilization for commercial patients shifted downward by 19.6% and resulted in an increase of 28.2% in clinic utilization. Medicaid patients' ED utilization shifted downward by 28.9% and clinic utilization increased by 24.7%. Medicare patients' ED utilization shifted downward by 9.8% and increased clinic use up by 7.4%.

Conclusion: The overall impact of this ED discharge referral process was that after being scheduled via the Caregiver Online Scheduling model, the majority of patients' reliance on the ED for their primary care needs has shifted to the patient-centered medical homes (PCMH), irregardless of their payer type. According to the PCMH, our model is successful as it upholds the principle of centrally managing the patient's care in an outpatient setting. The Caregiver Online Scheduling ED discharge referral process has resulted in our health system achieving PCMH goals of patient care coordination and has led to increased ED savings, increased clinic revenue and optimization of integrated health care delivery as we move towards becoming an Accountable Care Organization.