Patients who visit the emergency department often return to the ED within 24 to 48 hours. Readmission occurs when patients still have concerns about their condition or medication. Hendricks Regional Health’s new Emergency Department Discharge Clinic provides follow-up care after emergency visits.
Amy Wilson, RN, discusses the importance of follow-up care, checking patient progress, and more details on the new clinic.
The Importance of Follow Up Care After a Visit to the Emergency Room
Featured Speaker:
Amy Wilson, RN
Amy Wilson, RN is Clinical Manager of the Outpatient Care Center at Hendricks Regional Health. Transcription:
The Importance of Follow Up Care After a Visit to the Emergency Room
Melanie Cole (Host): Patients who visit the Emergency Department are often back within 24 to 48 hours. Hendricks Regional Health recently implemented a new initiative to help decrease readmissions to their Emergency Department. My guest is Amy Wilson. She's a Registered Nurse and the Clinical Manager of the Outpatient Care Center at Hendricks Regional Health. Amy, tell us a little bit about what happens in the Emergency Room, and then what kinds of physicians somebody might see, and then their discharge, what happens next?
Amy Wilson (Guest): After the patient is seen in the ER by the physician that physician would then determine if the patient needs a follow-up appointment. Our goal is to prevent readmission to the hospital, and a lot of times, patients come back to the Emergency Department within 24 to 48 hours, so we want to take the place of that. We want that patient to follow up in our clinic, so the physician makes that determination if that patient should come into our clinic. They work with the social worker in the ER to get that patient that appointment.
Melanie: Amy, tell us about the importance of follow-up care — as you mentioned, return visits to the ER — tell us about follow-up care. What's involved?
Amy: When patients come to our clinic, they — a lot of times, we find something new that they need assistance with or they left the ER and couldn't remember exactly what they were supposed to do. Our goal is to determine are they taking their medications correctly? Do they need a dressing change? Do they need further follow-up? We have sent patients to the Diabetic Centers of Excellence, here at Hendricks. We have also set patients up with physical therapy, occupational therapy; we may have sent them to our wound clinic for further follow-up. We may also need to change their antibiotics. The antibiotics they left from the ER may not be working as we want them to, so we will see them up with our AB clinic for possible IV antibiotics or change their oral antibiotics. We want to make sure that we keep that patient on the right track to wellness.
Melanie: What do you want people that are being discharged to know as far as support systems and if they had chest pain and you found that it was not really anything, following up with something like that with their primary care provider?
Amy: We do assist that patient, like I said, on the continuum of care. We will either if they do not have a primary care physician, we will work with the patient and get them set up with a primary care physician. Maybe they need a specialist. Maybe they need to see a cardiologist, so we will also work during that appointment to get them set up with a cardiologist also. We will just provide whatever service that the patient needs. We're going to assist them so that they are not alone.
Melanie: So, you've implemented this follow-up clinic, what do you see as some of the barriers to good follow-up care? I mean, the reason you guys implemented this in the first place, what were you seeing, and what are you seeing now that you've implemented this clinic?
Amy: A lot of patients don't have a primary care physician, so I believe that's why a lot of them will come back to the ER. If, for whatever reason, whatever their diagnosis was that they were seen in the ER, if that condition is worsened, then instead of going to follow-up with a doctor — or maybe they even if they have a doctor, but they feel that they can't get into that doctor they will use the ER for that service. We want to eliminate that. We want to be that point of care in between. We want to make sure that patient is getting the correct follow-up.
We have seen a lot of times — we're getting these people at times — with their appointment with us, the social worker may have actually put them in touch with a primary care physician and actually canceled their appointment. With this service, the Emergency Room social workers are working closely with us on this. If they're able to get a patient into a PCP before their appointment with us in the next couple of days, then we'll cancel this appointment, and the patient won't need to follow up with us. It's all about getting that patient services that a lot of times, they aren't able to find on their own. We are that resource for these patients. They just aren't able to navigate the system on their own, and sometimes they just need that little assistance to get them to where they need to be.
Melanie: What about after that clinic appointment? If they see you within a few days after leaving the ER and maybe you have given them a cardiologist to see or maybe referred them to a primary care provider, then what? Is it their responsibility then? How do we keep track of what they're doing?
Amy: At this point, there isn't a nurse navigator in the Emergency Department, and as I said, they're social workers, so there are follow up phone calls being made with these patients.
Melanie: That's fantastic. What would you like these patients to know about adherence to whatever they learn at the ER — because they're working with you, they're going to the clinic afterwards, and then adherence to whatever it is that you are trying to get them to do, whether it's seeing that primary care provider or change some things in their lifestyle?
Amy: Yeah, I think it's just very important that patients know the importance enough of following through with their appointments whether it be in our clinic, in their primary care doctor appointment, or their cardiologist appointment. Whatever they're being set up for, it's just so important that the patient does follow through with those appointments. We want just to make sure that they're comfortable and that they know that we are here for them. It's a very confusing time for them. A lot of times, patients haven't ever been sick before, so really, we are navigators for them to get them to the next level of their care.
Melanie: What a great program. Tell listeners what you'd like them to know about coming to the Emergency Room in the first place, Amy. What do you want them to think about if they have time to think — if it's not something like a heart attack, God forbid — or their caregivers, their loved ones, what do you want them to bring with them? What do you want them to know about what to expect at the ER?
Amy: The ED workers, the nurses, the social workers, the doctors, the physicians' assistants, they are all very compassionate. They are there for the patient; they want that patient to get to the next level, feel comfortable in their care, and feel comfortable that whatever they're there in the Emergency Department for those workers are there for them. They will help get them to the next level of care, to get them to feel comfortable in the situation that they're currently in.
Melanie: It can be scary to go to the Emergency Room, especially for parents.
Amy: Right.
Melanie: What would you like them to know about what you do there and about speaking to the doctor who's taking care of their child? What do you want parents to know, specifically?
Amy: Parents should know they're always the first contact between their child and the doctor. The care workers in the ED, they're going to listen to that parent. That parent knows that child better than anyone. Of course, those questions are going to be addressed to those parents, and parents should just feel free to ask any — feel comfortable to ask that worker anything that they need to know to further the care of that child.
Melanie: That's so important. What a great idea that you've implemented at Hendricks. Wrap it up for us, what you want the listeners to know about the importance of follow up care after an ER visit?
Amy: I really want patients and the community to know Hendricks' commitment to patients. We want to stay connected with our patients. We want to offer them a convenient continuum of care. We are there for them; we want them to feel comfortable, and we want to address all of their questions and just get them to that next level of care.
Melanie: Thank you so much, Amy, for being with us today and for sharing your expertise on this great topic. This is Health Talks with HRH, Hendricks Regional Health. For more information, please visit Hendricks.org, that's Hendricks.org. This is Melanie Cole. Thanks so much, for tuning in.
The Importance of Follow Up Care After a Visit to the Emergency Room
Melanie Cole (Host): Patients who visit the Emergency Department are often back within 24 to 48 hours. Hendricks Regional Health recently implemented a new initiative to help decrease readmissions to their Emergency Department. My guest is Amy Wilson. She's a Registered Nurse and the Clinical Manager of the Outpatient Care Center at Hendricks Regional Health. Amy, tell us a little bit about what happens in the Emergency Room, and then what kinds of physicians somebody might see, and then their discharge, what happens next?
Amy Wilson (Guest): After the patient is seen in the ER by the physician that physician would then determine if the patient needs a follow-up appointment. Our goal is to prevent readmission to the hospital, and a lot of times, patients come back to the Emergency Department within 24 to 48 hours, so we want to take the place of that. We want that patient to follow up in our clinic, so the physician makes that determination if that patient should come into our clinic. They work with the social worker in the ER to get that patient that appointment.
Melanie: Amy, tell us about the importance of follow-up care — as you mentioned, return visits to the ER — tell us about follow-up care. What's involved?
Amy: When patients come to our clinic, they — a lot of times, we find something new that they need assistance with or they left the ER and couldn't remember exactly what they were supposed to do. Our goal is to determine are they taking their medications correctly? Do they need a dressing change? Do they need further follow-up? We have sent patients to the Diabetic Centers of Excellence, here at Hendricks. We have also set patients up with physical therapy, occupational therapy; we may have sent them to our wound clinic for further follow-up. We may also need to change their antibiotics. The antibiotics they left from the ER may not be working as we want them to, so we will see them up with our AB clinic for possible IV antibiotics or change their oral antibiotics. We want to make sure that we keep that patient on the right track to wellness.
Melanie: What do you want people that are being discharged to know as far as support systems and if they had chest pain and you found that it was not really anything, following up with something like that with their primary care provider?
Amy: We do assist that patient, like I said, on the continuum of care. We will either if they do not have a primary care physician, we will work with the patient and get them set up with a primary care physician. Maybe they need a specialist. Maybe they need to see a cardiologist, so we will also work during that appointment to get them set up with a cardiologist also. We will just provide whatever service that the patient needs. We're going to assist them so that they are not alone.
Melanie: So, you've implemented this follow-up clinic, what do you see as some of the barriers to good follow-up care? I mean, the reason you guys implemented this in the first place, what were you seeing, and what are you seeing now that you've implemented this clinic?
Amy: A lot of patients don't have a primary care physician, so I believe that's why a lot of them will come back to the ER. If, for whatever reason, whatever their diagnosis was that they were seen in the ER, if that condition is worsened, then instead of going to follow-up with a doctor — or maybe they even if they have a doctor, but they feel that they can't get into that doctor they will use the ER for that service. We want to eliminate that. We want to be that point of care in between. We want to make sure that patient is getting the correct follow-up.
We have seen a lot of times — we're getting these people at times — with their appointment with us, the social worker may have actually put them in touch with a primary care physician and actually canceled their appointment. With this service, the Emergency Room social workers are working closely with us on this. If they're able to get a patient into a PCP before their appointment with us in the next couple of days, then we'll cancel this appointment, and the patient won't need to follow up with us. It's all about getting that patient services that a lot of times, they aren't able to find on their own. We are that resource for these patients. They just aren't able to navigate the system on their own, and sometimes they just need that little assistance to get them to where they need to be.
Melanie: What about after that clinic appointment? If they see you within a few days after leaving the ER and maybe you have given them a cardiologist to see or maybe referred them to a primary care provider, then what? Is it their responsibility then? How do we keep track of what they're doing?
Amy: At this point, there isn't a nurse navigator in the Emergency Department, and as I said, they're social workers, so there are follow up phone calls being made with these patients.
Melanie: That's fantastic. What would you like these patients to know about adherence to whatever they learn at the ER — because they're working with you, they're going to the clinic afterwards, and then adherence to whatever it is that you are trying to get them to do, whether it's seeing that primary care provider or change some things in their lifestyle?
Amy: Yeah, I think it's just very important that patients know the importance enough of following through with their appointments whether it be in our clinic, in their primary care doctor appointment, or their cardiologist appointment. Whatever they're being set up for, it's just so important that the patient does follow through with those appointments. We want just to make sure that they're comfortable and that they know that we are here for them. It's a very confusing time for them. A lot of times, patients haven't ever been sick before, so really, we are navigators for them to get them to the next level of their care.
Melanie: What a great program. Tell listeners what you'd like them to know about coming to the Emergency Room in the first place, Amy. What do you want them to think about if they have time to think — if it's not something like a heart attack, God forbid — or their caregivers, their loved ones, what do you want them to bring with them? What do you want them to know about what to expect at the ER?
Amy: The ED workers, the nurses, the social workers, the doctors, the physicians' assistants, they are all very compassionate. They are there for the patient; they want that patient to get to the next level, feel comfortable in their care, and feel comfortable that whatever they're there in the Emergency Department for those workers are there for them. They will help get them to the next level of care, to get them to feel comfortable in the situation that they're currently in.
Melanie: It can be scary to go to the Emergency Room, especially for parents.
Amy: Right.
Melanie: What would you like them to know about what you do there and about speaking to the doctor who's taking care of their child? What do you want parents to know, specifically?
Amy: Parents should know they're always the first contact between their child and the doctor. The care workers in the ED, they're going to listen to that parent. That parent knows that child better than anyone. Of course, those questions are going to be addressed to those parents, and parents should just feel free to ask any — feel comfortable to ask that worker anything that they need to know to further the care of that child.
Melanie: That's so important. What a great idea that you've implemented at Hendricks. Wrap it up for us, what you want the listeners to know about the importance of follow up care after an ER visit?
Amy: I really want patients and the community to know Hendricks' commitment to patients. We want to stay connected with our patients. We want to offer them a convenient continuum of care. We are there for them; we want them to feel comfortable, and we want to address all of their questions and just get them to that next level of care.
Melanie: Thank you so much, Amy, for being with us today and for sharing your expertise on this great topic. This is Health Talks with HRH, Hendricks Regional Health. For more information, please visit Hendricks.org, that's Hendricks.org. This is Melanie Cole. Thanks so much, for tuning in.