Personalized Care Plans: Are They Effective in Decreasing ED Visits and Health Care Expenditure Among Adult Super-Utilizers?

PROBLEM: Super-utilizers comprise 4.5% to 8% of all ED patients, but account for 21% to 28% of all ED visits. Excessive use of the emergency department contributes to increased health care costs, recurrent and unnecessary ED workup, decreased emergency readiness, and reduced staff morale. METHODS: The impact of personalized care plan implementation was evaluated using a within-subjects pre-post design. The number of ED visits for each enrolled patient (N = 65) were analyzed before and after personalized care plan enrollment at 90, 180, and 365 days. A post-hoc analysis was completed for each ED visit that resulted in a disposition of discharge. Total and average charges from the ED visits were analyzed to determine the intervention's effect on health care expenditure. Staff was anonymously surveyed to assess perceived efficacy and level of satisfaction with the intervention before completion of data collection. RESULTS: Median ED visits had a statistically significant decrease over 90, 180, and 365 days. There was also a decrease in median, average, and total ED charges for all time points. ED staff perceived the personalized care plans to be an effective intervention and were satisfied with their implementation. DISCUSSION: Personalized care plans effectively decreased the number of ED visits, reduced health care expenditure, and were well-received by the staff.

Does the addition of Vocera hands-free communication device improve interruptions in an academic emergency department?

OBJECTIVE: Emergency department (ED) interruptions occur frequently. Recently, a hands-free communication device (HCD; Vocera) was added to the population of communications devices (a cellular telephone and a pager) in our ED. The research purpose was to determine whether this addition improved interruption times and our hypothesis was the device would decrease length of interruptions. METHODS: This was a prospective cohort study of interruptions in an academic ED level 1 trauma center before and after introduction of an HCD. Interruptions were defined a priori and based on previous literature. We studied a convenience sampling of shifts. Length of interruption time was recorded. Three investigators collected interruption data, including nine different ED attendings. RESULTS: Of 511 interruptions, there were no significant differences in types of interruptions pre- versus post-HCD. Before HCD use, we collected 40 hours of data with 65 interruptions (mean 1.6/hour). Post-HCD, 180 hours of data were collected with 446 interruptions (mean 2.5/hour). There was a significant difference in length of time of interruptions, with an average of 9 minutes pre-HCD versus 4 minutes post-HCD (P = 0.012 diff 4.9; 95% confidence interval 1.8-8.1). HCD calls were significantly shorter than non-HCD calls (1 vs 5 minutes; P < 0.001). Comparing data collectors for type of interruption during the same 4-hour shift resulted in κ = 0.73. CONCLUSIONS: The addition of Vocera HCD may improve interruptions by shortening call length.