LONG BRANCH — The use of hospital emergency departments for non-emergency health care has long been a concern of providers and policymakers.
Their concern is that emergency rooms (ERs) are not able to provide continuity of care, ongoing patient education, or chronic care management, according to a press release from Monmouth Medical Center (MMC).
To address this concern, the Long Branch-based MMC, which is an affiliate of the St. Barnabas Health Care System, has begun a 21-month study designed to encourage and support the transition of patients from the hospital emergency department (ED) to appropriate community providers for their primary-care needs.
As one of only two sites in New Jersey to pilot this program, MMC will test a model of providing alternate non-emergency services to patients who depend on the hospital for their primary-care needs, as well as providing patient education and support services to encourage the use of more appropriate sites of care.
Newark Beth Israel Medical Center, MMC’s sister hospital, is the other hospital selected to pilot the program.
“Studies have found that a number of ED visits are for non-urgent medical care that would be more appropriately treated in primary-care settings,” said Frank J. Vozos, executive director of MMC.
“Directing non-urgent care to primarycare settings can improve the coordination of care for patients and preserve the ER for those who truly need emergency care,” Vozos said.
Vozos points to services such as the primary care clinic opened in downtown Long Branch by MMC in 1997 to increase access to primary care as testament to the hospital’s continuing commitment to care for the community’s medically underserved in the most appropriate setting.
“In 2004, in order to further increase that access, Monmouth Medical Center asked the federal government to approve a new, independent entity known as Monmouth Family Health Center,” Vozos said.
“And as a Federally Qualified Health Center, it has continued to serve medically underserved patients and increase outreach and support services to be even more responsive to the complex needs of our service area population,” he added.
Inappropriate use of the ED is a problem that leads to overcrowding and can impede care for those with more emergent conditions, according to Catherine Hanlon, chair of emergency medicine at MMC, who said the use of the ED for non-emergency conditions can be an indicator of access barriers to more appropriate primary care.
Hanlon explained that the Community Partnership for Emergency Department Express Care and Case Management project is designed to address social issues that create barriers to care, including illiteracy, language barriers, homelessness, and/or lack of transportation, as well as financial barriers, since patients are often covered by Medicaid or may be eligible for benefits but have not applied for them.
“While many urban ED visits occur for non-urgent conditions, such as upper respiratory infections, viral infections, earaches and sore throats, we understand that because these individuals typically face a multitude of barriers in accessing other providers, the ED becomes their provider of choice,” Hanlon said.
“The purpose of this pilot project is both to improve the health of the patients and to teach them to seek services from appropriate locations rather than the ED,” Hanlon added.
The use of hospital emergency departments for conditions that would be more appropriately cared for in a primary-care setting is a growing problem nationwide but is particularly acute in New Jersey, where about 18 percent of all hospital ED visits in a typical year were for primary-care conditions, according to the New Jersey Hospital Association’s (NJHA) Health Research and Educational Trust, which is implementing the pilot program jointly with the New Jersey Department of Human Services’ Division of Medical Assistance and Health Services and the New Jersey Primary Care Association.
“We want to ensure that patients receive the right care, at the right time, in the right setting,” said Betsy Ryan, NJHA president and chief executive officer.
As part of the project’s requirements, all patients who come to the ED will be triaged and receive a medical screening by an advanced practice nurse (APN), according to Hanlon.
“Once a patient is determined to have non-emergency primary-care needs, the APN will provide express primary care services and prescriptions and then schedule a follow-up appointment with a primary care provider in the community, such as a doctor, or at a health center such as the Monmouth Family Health Center,” Hanlon said. “All uninsured patients will also be screened for eligibility in public health coverage programs.”
Throughout the pilot program, case managers will monitor ED use, track compliance with follow-up visits, identify repeat ED users, determine their reason for using the ED for non-emergency conditions, and help them resolve barriers to using appropriate primary-care sites. The ED Express Care pilot program will primarily target Medicaid patients, but its ultimate goal is to provide care to all New Jersey residents in the most appropriate, efficient and cost-effective site.
“Ultimately, the study seeks to create a system that is more user-friendly and more responsive to individual needs of all patients,” said Firoozeh Vali, vice president of research for NJHA.
To learn more about emergency services at MMC, call 1-888-SBHS-123 or visit www.saintbarnabas.com.