Overuse of EMS Services Case Study
What is the Problem here?
Within emergency departments, there is a common systems problem regarding the geriatric frequent fliers in hospitals that use emergency services for non-emergent events, geriatric is defined as those aged 65 years or older, by calling frequently for their chronic issues, or other non-emergent episodes in which these patients are able to visit primary care physicians over the emergency department.
Why is this a problem?
Because these patients create extra expenditures for the hospital as well as taking resources away from others who may need the emergency medical services (or services from the police force, as they also have been serving as emergency medical assistance) even though it is going to the patient in need, it is being taken away from others that may need the services and resources for actual medical emergencies.
The outcomes related to this system problem is that resources are unbalanced and are being used for certain individual’s non-emergent episodes when these sources should not be allocated in this way.
Vision Statement …
as part of the deliverable for hospitals, clinics, healthcare reform, and health care specialists:
In 5 years our team wants to restructure the way we treat current frequent flyers to provide the actual care that is needed so that we may reduce hospital and patient costs as well as allocate resources responsibly. We expect to have 80% less frequent flyers with these interventions.
Methods
In addition to peer reviewed articles and literature reviews, the following methods were utilized in the analysis of this process improvement work flow:
Flowing Through the Motions
This flow diagram highlights the steps patients take when undergoing the frequent flyer thought process.
Diagraming the Set Backs
This diagram illustrated the set back these patients have and why they feel the need to take the measures they do when frequently requesting EMS services.
Breaking out the 5 Why’s
Why?
For these patients it is easier to dial 911 than it is to call their PCP and set up a visit to follow up with.
Why?
It is difficult for patients without technology knowledge to go through the online process of setting up a patient portal and inputting patient information as well as looking up follow up information such as lab results.
Why?
These patients do not know how to use technology without assistance.
Why?
Most likely, they do not have a computer or access to a computer or internet.
Why?
This demographic did not grow up with technology and it is considered a foreign concept.
Analysis:
Information gathered confirms that this issue is related to the digital divide. It could be that this population does not know how to use technology or does not have access although technology has advanced. Possibly internet services are not offered in their area or they do not have anyone who is able to help them navigate and utilize their appropriate resources. Appropriate resources include scheduling appointments online, reading test results, recording health information (weight, blood pressure, etc.), reminders, etc. A lot of follow up and communication is now occurring in the digital space and this cohort of the population is not completely adept at this new technology.
Digital Divide: the economic, educational, and social inequalities between those who have computers and online access and those who do not.
Conclusion
Solutions to ameliorate these barriers would be to consider alternatives that do not involve using technology or the internet. There are many ways of following up with patients.
Phone calls
Surveys
Post service mail
Caretakers completing home visits
At home health recording devices (heart rate monitor, glucose monitor, oxygen monitor, etc.)
At home treatments
Barriers to consider:
Lack of funding
Difficulty in explaining that preventative measures save money in the long run
Others wanting immediate results
Teaching the geriatric population to utilize technology
Patients not being able to hear phone calls (hearing aids)
Patients who do not open the door to strangers (even if it may be medical staff)
Some of these patients may not want to make the change to comply with using appropriate resources, as it may be easier to call 911, however, implementing other measures will ensure success in their care and in the overall system. The implementation of the Vision Statement is feasible when many clinics and hospitals take part of the implementation and incorporate it in their day to day work flows.