Disease Management Update
Volume V, No. 34
January 8, 2009

Dear Healthcare Intelligence Network Client,

According to the U.S. Census Bureau, more than 45 million Americans are uninsured. As if hospital EDs weren't overcrowded to begin with, job losses and delays in seeking healthcare are causing an influx of patients to EDs across the nation. This week's DM Update highlights ED overcrowding, increased wait times and one health system's response to Massachusetts' new "no diversion" policy, despite problems with overcrowding.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy at http://www.hin.com/freenews2.html where you can also learn about our other complimentary news services.

Table of Contents

  1. Florida Receives Second C- for Emergency Care
  2. Disease Management Q&A: Reducing ED “Frequent Fliers”
  3. HealthSounds Podcast: A Team Approach to Addressing ER Overcrowding
  4. Hallmark Health ERs Prepared for "No Diversion" Policy
  5. Survey of the Month: ED Access and Overcrowding
  6. Dealing with Unnecessary ED Visits

1. Florida Receives Second C- for Emergency Care

The American College of Emergency Physicians (ACEP) has released its 2009 National Report Card on the State of Emergency Medicine, giving Florida a ‘C-’ grade for the second time. Florida ranks 30th out of the 50 states and the District of Columbia. The National Report Card is an assessment of the support that each state provides for its emergency medicine system. ACEP prepared this report to underscore the challenges facing patients who need access to emergency care, as well as to recognize efforts being made to address their needs. Florida’s C- reflects the overall C- grade that the United States received as a whole.

“We are disappointed that Florida’s grade has not improved since the release of the 2006 Report Card,” said FCEP President Ernest Page II, M.D., FACEP. “We’re very pleased that Florida is one of the nation’s leaders in disaster preparedness, but it is disappointing to see a grade of ‘F’ on access to emergency care. As an organization, we are committed to finding ways to improve access to emergency care for our patients, and we offer our assistance to the governor’s office and the Florida legislature in helping to find solutions to our challenges, which continue to be uninsured using the ER as primary care, overcrowding, uncompensated care, a shortage of medical specialists and a lack of inpatient beds.”

Florida fell below the national median largely due to poor scores in public health and injury prevention (D-), medical liability environment (C-), and the most heavily weighted of the five categories, access to emergency care (F). Florida was one of only 12 states to receive an ‘F’ in that category, and ranked 50th nationally, finishing only ahead of California. The major issues cited were too few emergency facilities for Florida’s residents, a large number of uninsured, a lack of psychiatric care beds, a dearth of PCPs, a low number of physicians who accept Medicare, a scarcity of specialists and registered nurses, a lack of injury prevention funds and a low ranking for vaccinations for the elderly. Florida’s best grades came in the quality and patient safety environment category (A-), and disaster preparedness (A-), a new category for the 2009 Report Card.

FCEP will continue its support and development of the Emergency Medicine Learning & Resource Center (EMLRC), an educational facility which will be housed in Orlando and dedicated to promoting and advancing emergency medicine, disaster management, pre-hospital emergency care and public health by providing education and research activities. The presence of the EMLRC will help raise Florida’s grades in several categories.

To improve the state’s grade in public health and injury prevention (D-), FCEP will support legislation committed to injury prevention programs and seek the reinstatement of helmet laws and for tougher seatbelt legislation. FCEP also supports programs aimed at heightened awareness of immunization and prevention. “The low vaccination rate among Florida’s seniors continues to contribute to the state’s high number of hospital admissions from emergency departments,” said Dr. Page. “With flu season upon us, we encourage our lawmakers to prioritize the creation of awareness programs about the importance of vaccinations.”

To learn more about this research, please visit:

2. Disease Management Q&A: Reducing ED “Frequent Fliers”

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Julie Szempruch, associate vice president and chief nursing officer for the Midtown Mental Health Center, part of Wishard Health Services in Indiana.

Question: Have your programs reduced the number of “frequent fliers” or “super-users” in the medical ED?

Response: (Julie Szempruch) With our daily conference call, if we notice that there’s a name that continues to come up for being in one of our various acute care facilities — not only inpatient — then we come together and plan what needs to happen. Frequently, the entire treatment team sits down with a patient and tries to find out what we’re missing and how we can provide better services to them. The conference call has definitely streamlined our ability to work with people that frequent the ED. We point some of the highest frequent fliers to our assertive community treatment teams, which are available to them 24 hours a day, versus using the ED. They would be seen by or have phone access to those people.

For more details on reducing ED utilization, please visit:

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3. HealthSounds Podcast: A Team Approach to Addressing ER Overcrowding

Delaying of healthcare for economic reasons is causing volatility in hospital ER volumes that is expected to intensify. To handle staffing, equipment and treatment challenges posed by these census variations, hospital EDs must rethink processes and protocols. At Edward Hospital in Naperville, Il., a "culture of certification" that includes cash bonuses for certification and peer support during exam preparation helps to raise the caliber of the ER staff and maintain patient satisfaction levels. Cindy Rentsch, Edward Hospital's clinical director of emergency services, describes the "we can do it" attitude that pervades the Edward ER, a marketing campaign that has diverted patients with behavioral health issues from the ER and strategies to improve turnaround times and treatment for pediatric ER patients. Rentsch will be joined by Joan Heater, director, Banner Gateway Medical Center and Kevin Roche, director of the management engineering program at Banner Gateway Medical Center, during Emergency Room Utilization: Developing a Team Approach to Address Overcrowding Factors That Increase Wait Time, a January 14, 2009 webinar. The three presenters will share organizational strategies that improve throughput in the ER as well as increase efficiencies, reduce costs and improve patient outcomes and satisfaction.

To listen to this complimentary HIN podcast, please visit:

4. Hallmark Health ERs Prepared for "No Diversion" Policy

Hallmark Health System fully prepared for the launch of Massachusetts' new "No Diversion" policy, which states no hospital ER will be able to divert incoming ambulances to other hospitals. The policy, which went into effect on Jan. 1, 2009, was designed to prohibit hospitals from diverting patients to other hospitals' ERs to avoid overcrowding in their own facilities. The only exception will be if there is an emergency such as a fire or environmental contamination within the hospital.

Although both Lawrence Memorial Hospital of Medford and Melrose-Wakefield Hospital have a history of rarely going on diversion, Hallmark Health is taking the necessary steps to prepare its staff for what could be an influx of patients. A committee of Hallmark Health physicians, nursing staff, hospitalists and administrators have been meeting regularly to prepare for the launch of this policy. A preemptive plan, which includes looking at staffing and patient patterns as well as brainstorming sessions on best practices for expediting discharges, is also in place.

In recent years both Hallmark Health hospitals have pursued a number of strategies to improve patient flow so they move efficiently and expeditiously through the system. Staff in the ED, along with the bed coordinator, utilizes the new electronic tracking system to assign in-house beds. This helps to alleviate backups in the ER.

"We are fully prepared for the launch of the 'No Diversion' policy," said Steven Sbardella, M.D., chairman of emergency services for Hallmark Health System. "We are ready and waiting to deliver the best in quality care to our patients. We want to get them into the emergency department as quickly as possible so that they can be treated."

To learn more about this research, please visit:

5. Survey of the Month: ED Access and Overcrowding

An economy that is creating more unemployed and uninsured individuals is just one factor contributing to a rise in ER use and a decline in patient satisfaction. In its National Report Card on the State of Emergency Medicine for 2009, the American College of Emergency Physicians has given the United States an overall grade of C-, largely due to poor ratings for access to emergency care. Is emergency room overcrowding an issue for your organization, and if so, how are you responding to this? Complete HIN's Survey of the Month on emergency room access and overcrowding and receive a free executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. Dealing with Unnecessary ED Visits

In an effort to curb non-emergent ED use, hospitals and health plans nationwide are developing strategies to reduce reliance on EDs for non-emergent care. In a non-scientific online survey, HIN found out how 220 organizations including hospitals, physician organizations, health plans and more respond to the issue of non-emergent ED use.

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Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

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