1. Project Spotlight ED Care Triage (2biii)
Sherry Buglione MS, RN
Director of Integrated Care & Strategy Deployment
Oneida Healthcare
May 26, 2016

2. ED Care Triage Project (2biii)
The Goal:
Identify individuals with an ambulatory sensitive condition (ASC) or potentially preventable visit (PPV) and connect them to a Primary Care Provider.
CNYCC defined criteria for the target population:
Each ED’s own clinical determination of an ambulatory sensitive condition OR
Have an Emergency Severity Index level 3, 4, or 5 (entity must provide protocol for classification of an ESI 3)
Oneida 2015 ED Data Analysis
32% of ED visits were Non-Urgent (triage level 4 & 5)
57% of non-urgent visitors had medicaid
30% did not have a PCP, or didn’t know who their PCP was
69% of Patients with >5 visits over 10 months were Medicaid

3. Oneida Healthcare Target Population
Patients who do not have a Primary Care Physician or do not know who their PCP is
6 or more ED visits over the previous 12 months.
Patients who are non-urgent ESI 4s & 5s.
ESI 3’s who in the providers clinical judgment deem appropriate

4. Beginning of the Patient Navigation Program
Presented ED Navigator position and 2015 data to Senior Leadership November 2015
Began bi-weekly meetings with CNO, ED Nurse Manager, Practice Manager, Care Coordinator at Practices, and Care Transition staff to discuss ED utilization
Developed interim program with Care Transitions Team for patients with no PCP
Attempted to reach patient after ED discharge: largely unsuccessful
Linda ~ she would need to secure appointments for 215 patients next year to pay for her salary.
Triggers built into Meditech
Alert on status board when patient presented to the ED with: no PCP, ESI of 4 or 5
or 6 or more visits in past12 months
Patient Navigator hired
Met with St. Joe’s Patient Navigator January 2016
Visited all area PCP offices and ED physician & staff meetings
Explained her role, the program, and made contacts with scheduling personnel at each office
Patient Navigator begins in Emergency Department February 2016
Patient Navigators

5. Patient Navigation Process
Proactively identify the patient through ED Alerts or discussion with clinical team.
Navigator hours M-F 9a-5p
Report 10am daily of patients who qualify for navigation after 5pm
Navigator attempts to contact them the following day
After medical screening (determines non-urgent visit) Patient Navigation begins
Meet with patient in ED room to introduce self and the program
Verify demographic information
Obtain desire & preferences for PCP
Identify barriers to access primary care
Offer to obtain follow-up appointment with PCP
Review proper utilization of ED & benefits of PCP with patient
If uninsured, refer to in-house Application Counselor
Refer to community services as needed
Refer to Health Home or notify Health Home Care Manager if enrolled

6. Patient Navigation Process
Scheduling of appointment:
Contact Practice Care Coordinator or PCP office to schedule appt. while patient in the ED
If scheduled; appointment card given to patient, with directions & phone number
Cannot schedule while in the ED (after hours or left ED) Patient notified within 2 days
Inform ED provider of F/U appointment to include in his Plan of Care
Documentation of all interactions and data fields in Meditech
For DSRIP reporting, performance improvement & quality measures
All ED patients receive follow-up phone call via Cipher Health within 72 hours of visit
Future plans: Identify Health Home patients in Meditech
Potential to perform PAM screenings
Open scheduling in our practices

7. Success to Date Challenges Linda has Navigated 234 patients
173 Medicaid, 61 other
37 appointments beyond 30 day requirement
24 Medicaid, 13 other
Appointments with specialists (Ortho, Dental, Women's Health, ENT)
Challenges
Saturation at Primary Care Practice, increased days to appointment
No- Show rate
Drug seeking patients
Navigator Coverage
Transmitting ED record to PCP
Monitoring improvement
After hour PCP answering machine (“call back in am”)

8. Questions & Answers