Emergency Department U-Turn


Advanced Home Care in Greensboro, North Carolina.

Agency Description:
Advanced Home Care has 13 home health branches in three states serving average of 5,500 patients daily. Advanced Home Care is Medicare/Medicaid certified and accredited by the Accreditation Commission for Health Care.
Population Impacted:
Chronic care patients that frequent the emergency department (ED) and would benefit from admission to home health from the emergency department. 
Strategic Partners:
Strategic partners in this program are hospital EDs, specifically the ED medical director and ED case management.
Project Description:
Advanced Home Care met with hospital ED staff, including the ED medical director and the case management staff that work in the ED. The Advanced Home Care sales staff worked with the ED staff to determine types of patients who would be the best fit to benefit from a home health referral. The process of how to conduct the referral was discussed, along with the best method of referral: paper or electronic. Together, both teams developed metrics to measure the number of admissions from the ED, payer source, discipline order, and if the patient was admitted to the hospital. The Advanced Home Care staff also provided education on home care to all three shifts of the ED staff, including physicians and nurses. 
Each month, Advanced Home Care receives an average six to eight referrals from the ED, of which, 80 percent are Medicare patients. 
Barriers to Implementation:
A key barrier to implementation was that new ED staff are unaware of the home health referral process as the ED staff are less focused on preventing readmissions than are hospitalists. Furthermore, the ED pace was so busy that many clinicians found it to be extra work on the discharge plan to refer to home health.