Shafer notes that navigator follow-through ensures that physicians accept the concept of redirecting nonemergent patients. "As physicians in the emergency department, a doctor will worry that this is our one chance to make the diagnosis on a patient, so we might order a full set of labs and other tests. However, if we know the patient is going to be seen and evaluated by another set of medical eyes within the next 12 to 24 hours, and continuity of care is going to be established with that patient, we don't need to do as intense a workup in the ED because we know that that's going to be taken care of."
Care continuum relationships
Healthcare leaders endorse communication as a way of fostering relationships along the continuum of care. Two-thirds (68%) are improving or expect to improve communications with primary care practices. And 61% are improving communication about their patients through improved integration of care partners' EHRs.
One-third of EDs (33%) have a strong working relationship with community-based clinics, a slight increase over last year's 28%.
Texas Health is in the Dallas-Fort Worth area, and the increased demand for healthcare that is accompanying population growth is straining primary care capacity at the same time it is increasing ED volume. Says Prosser, "Conceptually, if people are educated that they have other avenues of care, then they're going to choose those avenues rather than come to an emergency room and sit around for several hours. But part of the challenge in our community is that the primary care physicians are already busy, and by the sheer population growth, demand is outstripping supply, so patients have trouble getting into primary care offices."
Investments in care
Prosser notes that smooth transfers are a benefit of closer working relationships with care continuum partners. "We have worked with some of our postacute facilities to improve communications so that they will accept patients in transfer more readily, and with [EHR] information exchange, patient transfer is smoother and more efficient."
Shafer says information enhances care partnerships, fostering teamwork. "With EHRs, primary care providers can see exactly what happened in the emergency department. They see what tests were done, so they don't have to repeat any tests. If a diagnosis wasn't made and the patient was merely stabilized, they can see exactly what the next steps are in terms of the workup. This way, the ER becomes a full team member in care, whereas previously it was more episodic, and the ER didn't know what was going on in primary care."