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CHICAGO – Frequent flyers, patients with a history of at least five visits per year to the emergency department, might benefit from high-risk care plans, based on research from the University of Maryland health care system.

The plans are designed to improve patient safety by reducing exposure to ionizing radiation and have the additional benefit of reducing the costs of care, Dr. Leen Alblaihed, a resident physician at the university, reported at the annual meeting of the American College of Emergency Physicians.

After high-risk care plans were put into the emergency physician work flow for 41 patients with a history of high emergency department utilization, unneeded tests declined. Other important outcomes were statistically significant reductions in hospitalizations and quantities of prescribed opioids.

he patients considered for the study had to have at least five ED visits and three admissions per year. Based on the electronic medical record data of the university’s two suburban medical centers, a total of 845 patients met that definition.

The high-risk care plans for the management of the 41 patients were developed by a multi-disciplinary team of case managers, emergency physicians, and hospitalists. The plans were then integrated into the physician electronic documentation and work flow.

The data analysis was based on 23 of the patients, 10 men and 13 women with a median age of 48 years, who had 6 months of data before and 6 months of data after the care plan was instituted. The primary outcome measures were a reduction in ionizing radiation. Secondary outcome measures were reductions in ED visits, hospital admissions, observation stays, and opioid prescriptions based on morphine equivalent totals.

Compared to the data before the care plan was instituted, the 23 patients had nearly half as many x-rays and CT scans and a nearly sixfold reduction in prescribing of morphine equivalents. While ED visits decreased modestly from 116 to 82, the admission rates dropped from 99 to 37 and observation stays declined from 43 to 28.

The study group had decreases in all measures after high-risk care plans. X-ray studies decreased from 202 to 106, CT scans declined from 107 to 50, and opiate prescribing decreased from 3824 mg to 675 mg in morphine equivalents.

Because the outcomes were not normally distributed, medians and interquartile ranges were analyzed using the Wilcoxon signed-rank test to compare the pre/post median values (see table).

[email protected]

CHICAGO – Frequent flyers, patients with a history of at least five visits per year to the emergency department, might benefit from high-risk care plans, based on research from the University of Maryland health care system.

The plans are designed to improve patient safety by reducing exposure to ionizing radiation and have the additional benefit of reducing the costs of care, Dr. Leen Alblaihed, a resident physician at the university, reported at the annual meeting of the American College of Emergency Physicians.

After high-risk care plans were put into the emergency physician work flow for 41 patients with a history of high emergency department utilization, unneeded tests declined. Other important outcomes were statistically significant reductions in hospitalizations and quantities of prescribed opioids.

he patients considered for the study had to have at least five ED visits and three admissions per year. Based on the electronic medical record data of the university’s two suburban medical centers, a total of 845 patients met that definition.

The high-risk care plans for the management of the 41 patients were developed by a multi-disciplinary team of case managers, emergency physicians, and hospitalists. The plans were then integrated into the physician electronic documentation and work flow.

The data analysis was based on 23 of the patients, 10 men and 13 women with a median age of 48 years, who had 6 months of data before and 6 months of data after the care plan was instituted. The primary outcome measures were a reduction in ionizing radiation. Secondary outcome measures were reductions in ED visits, hospital admissions, observation stays, and opioid prescriptions based on morphine equivalent totals.

Compared to the data before the care plan was instituted, the 23 patients had nearly half as many x-rays and CT scans and a nearly sixfold reduction in prescribing of morphine equivalents. While ED visits decreased modestly from 116 to 82, the admission rates dropped from 99 to 37 and observation stays declined from 43 to 28.

The study group had decreases in all measures after high-risk care plans. X-ray studies decreased from 202 to 106, CT scans declined from 107 to 50, and opiate prescribing decreased from 3824 mg to 675 mg in morphine equivalents.

Because the outcomes were not normally distributed, medians and interquartile ranges were analyzed using the Wilcoxon signed-rank test to compare the pre/post median values (see table).

[email protected]

CHICAGO – Frequent flyers, patients with a history of at least five visits per year to the emergency department, might benefit from high-risk care plans, based on research from the University of Maryland health care system.

The plans are designed to improve patient safety by reducing exposure to ionizing radiation and have the additional benefit of reducing the costs of care, Dr. Leen Alblaihed, a resident physician at the university, reported at the annual meeting of the American College of Emergency Physicians.

After high-risk care plans were put into the emergency physician work flow for 41 patients with a history of high emergency department utilization, unneeded tests declined. Other important outcomes were statistically significant reductions in hospitalizations and quantities of prescribed opioids.

he patients considered for the study had to have at least five ED visits and three admissions per year. Based on the electronic medical record data of the university’s two suburban medical centers, a total of 845 patients met that definition.

The high-risk care plans for the management of the 41 patients were developed by a multi-disciplinary team of case managers, emergency physicians, and hospitalists. The plans were then integrated into the physician electronic documentation and work flow.

The data analysis was based on 23 of the patients, 10 men and 13 women with a median age of 48 years, who had 6 months of data before and 6 months of data after the care plan was instituted. The primary outcome measures were a reduction in ionizing radiation. Secondary outcome measures were reductions in ED visits, hospital admissions, observation stays, and opioid prescriptions based on morphine equivalent totals.

Compared to the data before the care plan was instituted, the 23 patients had nearly half as many x-rays and CT scans and a nearly sixfold reduction in prescribing of morphine equivalents. While ED visits decreased modestly from 116 to 82, the admission rates dropped from 99 to 37 and observation stays declined from 43 to 28.

The study group had decreases in all measures after high-risk care plans. X-ray studies decreased from 202 to 106, CT scans declined from 107 to 50, and opiate prescribing decreased from 3824 mg to 675 mg in morphine equivalents.

Because the outcomes were not normally distributed, medians and interquartile ranges were analyzed using the Wilcoxon signed-rank test to compare the pre/post median values (see table).

[email protected]

CHICAGO – About 11% of national health expenditures are related to emergency department–directed health care, with 7% of all expenditures from ED admissions and 4% of all expenditures from outpatient ED visits, Dr. Jessica Galarraga reported at the annual meeting of the American College of Emergency Physicians.

Based on volume, hospital admissions from the ED were about 11% of all emergency visits; however, they accounted for more than $182 billion or 62% of the costs of ED-directed care, said Dr. Galarraga of the George Washington University in Washington.

Increasingly, the ED is the “front door” for hospital care, as noted in a RAND report published last year.

With ED-directed health care comprising more than 11% of national health expenditures (NHE), it is important for ED providers to work collaboratively with other parts of the health care system to safely reduce health care costs, Dr. Galarraga said.

Potentially avoidable ED-directed encounters, including nonemergent visits, emergent but preventable visits, and ambulatory care sensitive condition (ACSC) admissions, together accounted for 1.8% of NHE. “Given the relative importance of ED admissions over outpatient encounters, making use of the emergency physician’s role as a gatekeeper to admission may be the most effective way to reduce costs,” she said.

Dr. Galarraga and her colleagues examined the costs of ED care and ED-directed health care by visit categories to provide a better understanding of the potential magnitude of cost savings from interventions directed at ED encounters.

The 2010 data from the Medical Expenditure Panel Survey (MEPS) were used to determine mean per-visit payments and charges for ED outpatient and inpatient encounters by visit type. National Hospital Ambulatory Medical Care Survey (NHAMCS) and the Healthcare Cost and Utilization Project (HCUP) were used to estimate the aggregate expenditures and proportional costs of NHE by each visit category. Outpatient encounters were categorized based on the New York University (NYU) classification and inpatient encounters by ACSC versus non-ACSC.

Among all encounters involving ED-directed health care, the greatest mean per-visit expenditures were attributable to hospital admissions from the ED, with mean payments of $12,817 and $9,708 for non-ACSC and ACSC admissions, respectively. Nonurgent outpatient ED visits generated the lowest mean per-visit expenditure of $819, even compared with all other outpatient ED encounters.

Dr. Galarraga had no relevant financial disclosures.

[email protected]

On Twitter @maryjodales

CHICAGO – About 11% of national health expenditures are related to emergency department–directed health care, with 7% of all expenditures from ED admissions and 4% of all expenditures from outpatient ED visits, Dr. Jessica Galarraga reported at the annual meeting of the American College of Emergency Physicians.

Based on volume, hospital admissions from the ED were about 11% of all emergency visits; however, they accounted for more than $182 billion or 62% of the costs of ED-directed care, said Dr. Galarraga of the George Washington University in Washington.

Increasingly, the ED is the “front door” for hospital care, as noted in a RAND report published last year.

With ED-directed health care comprising more than 11% of national health expenditures (NHE), it is important for ED providers to work collaboratively with other parts of the health care system to safely reduce health care costs, Dr. Galarraga said.

Potentially avoidable ED-directed encounters, including nonemergent visits, emergent but preventable visits, and ambulatory care sensitive condition (ACSC) admissions, together accounted for 1.8% of NHE. “Given the relative importance of ED admissions over outpatient encounters, making use of the emergency physician’s role as a gatekeeper to admission may be the most effective way to reduce costs,” she said.

Dr. Galarraga and her colleagues examined the costs of ED care and ED-directed health care by visit categories to provide a better understanding of the potential magnitude of cost savings from interventions directed at ED encounters.

The 2010 data from the Medical Expenditure Panel Survey (MEPS) were used to determine mean per-visit payments and charges for ED outpatient and inpatient encounters by visit type. National Hospital Ambulatory Medical Care Survey (NHAMCS) and the Healthcare Cost and Utilization Project (HCUP) were used to estimate the aggregate expenditures and proportional costs of NHE by each visit category. Outpatient encounters were categorized based on the New York University (NYU) classification and inpatient encounters by ACSC versus non-ACSC.

Among all encounters involving ED-directed health care, the greatest mean per-visit expenditures were attributable to hospital admissions from the ED, with mean payments of $12,817 and $9,708 for non-ACSC and ACSC admissions, respectively. Nonurgent outpatient ED visits generated the lowest mean per-visit expenditure of $819, even compared with all other outpatient ED encounters.

Dr. Galarraga had no relevant financial disclosures.

[email protected]

On Twitter @maryjodales

CHICAGO – About 11% of national health expenditures are related to emergency department–directed health care, with 7% of all expenditures from ED admissions and 4% of all expenditures from outpatient ED visits, Dr. Jessica Galarraga reported at the annual meeting of the American College of Emergency Physicians.

Based on volume, hospital admissions from the ED were about 11% of all emergency visits; however, they accounted for more than $182 billion or 62% of the costs of ED-directed care, said Dr. Galarraga of the George Washington University in Washington.

Increasingly, the ED is the “front door” for hospital care, as noted in a RAND report published last year.

With ED-directed health care comprising more than 11% of national health expenditures (NHE), it is important for ED providers to work collaboratively with other parts of the health care system to safely reduce health care costs, Dr. Galarraga said.

Potentially avoidable ED-directed encounters, including nonemergent visits, emergent but preventable visits, and ambulatory care sensitive condition (ACSC) admissions, together accounted for 1.8% of NHE. “Given the relative importance of ED admissions over outpatient encounters, making use of the emergency physician’s role as a gatekeeper to admission may be the most effective way to reduce costs,” she said.

Dr. Galarraga and her colleagues examined the costs of ED care and ED-directed health care by visit categories to provide a better understanding of the potential magnitude of cost savings from interventions directed at ED encounters.

The 2010 data from the Medical Expenditure Panel Survey (MEPS) were used to determine mean per-visit payments and charges for ED outpatient and inpatient encounters by visit type. National Hospital Ambulatory Medical Care Survey (NHAMCS) and the Healthcare Cost and Utilization Project (HCUP) were used to estimate the aggregate expenditures and proportional costs of NHE by each visit category. Outpatient encounters were categorized based on the New York University (NYU) classification and inpatient encounters by ACSC versus non-ACSC.

Among all encounters involving ED-directed health care, the greatest mean per-visit expenditures were attributable to hospital admissions from the ED, with mean payments of $12,817 and $9,708 for non-ACSC and ACSC admissions, respectively. Nonurgent outpatient ED visits generated the lowest mean per-visit expenditure of $819, even compared with all other outpatient ED encounters.

Dr. Galarraga had no relevant financial disclosures.

[email protected]

On Twitter @maryjodales