Implementing “ER is for Emergencies” Practice Guideline to Reduce Nonemergent Emergency Department Visits

Abstract

Introduction

More than half of all health care visits in the United States occur in the emergency department. These visits are the result of systems and policies that reduce primary care access. Patient linkage to primary care services is essential for improved health outcomes and effective emergency department care. This project aimed to implement a patient education and navigation program in a rural emergency department to reduce nonemergent emergency department visits and nurse workload and to improve patient enrollment in primary care patient-centered medical homes.

Methods

The project used a pretest-posttest design to determine the impact of the “ER is for Emergencies” clinical guideline on nonemergent emergency department visits and patient enrollment. The modified Need for Recovery Survey used a paired group analysis to assess the project’s impact on nurse workload and job satisfaction.

Results

A convenience sample of 38 primarily Black/African American (N = 35) and Medicaid-insured patients (N = 16) received nurse-led education and a referral to a patient-centered medical home. A comparison of pre- and postintervention chart reviews demonstrated a significant reduction in nonemergent emergency department visits after the intervention (P < .01) and improved participant enrollment in the patient-centered medical home (P = .04). Furthermore, the intervention was associated with reduced nurse-reported workload and stress (N = 7; P < .007).

Conclusion

The results of this quality improvement project are consistent with the broader literature that multimodal interventions can effectively reduce nonemergent emergency department visits and link patients to primary care. Multimodal interventions and policy solutions targeting structural inequities are urgently needed to support access to primary care and reduce nonemergent ED use.