Reducing Emergency Department Utilization Through Individualized Care Plans Developed by a Multidisciplinary Team.

PURPOSE OF STUDY: Frequent emergency department (ED) utilization often reflects complex medical, behavioral, and social needs that extend beyond episodic emergency care. The purpose of this project was to evaluate the implementation of individualized care plans created by a multidisciplinary team and describe changes in ED utilization among high-utilizing patients.

PRIMARY PRACTICE SETTINGS: Community hospital ED.

METHODOLOGY AND SAMPLE: A retrospective evaluation was conducted among 11 adult patients with 6 or more ED visits within a 12-month period. A team of ED stakeholders developed individualized care plans following a comprehensive assessment of each patient's unique needs. ED utilization during the 6 months before and after application of the care plans was compared, and patient characteristics were described.

RESULTS

After patients received care plans tailored to their specific needs, ED visits decreased by 66.5% during the 6-month follow-up period. Most participants were insured through Medicaid (72.7%), had at least 1 chronic medical condition (72.7%), and experienced social challenges such as unemployment (63.6%) and financial instability (45.5%).

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Individualized care plans were associated with reduced ED visits among high-utilizing patients. Collaboration among clinicians, case managers, social workers, behavioral health providers, and community resources can help address the multifaceted issues that contribute to high ED visits. Health care systems may consider implementing similar care planning approaches for high-utilizing patients.