In order to reduce emergency department visits, home health care providers should be honing in on relationships with primary care providers and patients.
That is the thesis of a new wide-ranging study conducted by researchers and clinicians at the University of Virginia Health.
“The increasing number of home health referrals after ED use in order to improve the transition from hospital to home points to the role that home health care providers can and should play in communicating with PCPs,” Catherine Harris, director of Continuum Home Health at the University of Virginia, said at the National Association for Home Care & Hospice’s (NAHC) annual conference last month. “Providers should be playing a larger role in educating and assisting patients with fostering a strong PCP relationship for health maintenance and prevention.”
As a way to investigate home health care’s role in reducing unnecessary ED visits for seniors, Harris and her colleagues investigated the prevalence of ED utilization among a group of home health patients.
The study reviewed 233 emergency department visits made by 195 home health patients and tried to pinpoint why patients made visits to the ED, whether or not those visits came before or after an in-home visit and if they had admitted themselves to the ED or if a home health aide recommended an ED visit.
The study found that 130 of those patients visited the ED after hours, meaning those visits likely were costlier and less convenient for hospital staff and for the patient. Meanwhile, 149 patients had spent between 1 and 8 hours at the emergency department.
“I have no doubt that our robust attempt to handle these calls and have our staff call the patient back is one of the reasons why so few of these were actually happening during office hours,” Harris said. “We found it fascinating that the vast majority,85, were in the ED for less than four hours — which speaks to the fact that they went in, they got turned around, they got dealt with for whatever that one issue was, and then they were sent back home.”
Of the 233 ED visits, 202 were sent home, while 30 were held for further observation.
“There was no primary care provider identified on the initial referral or admission paperwork in 52 of the patient records,” Harris said. “For those patients who were sent home from the emergency department, 87% of them had a PCP identified upon admission and were sent home from the emergency department. This led us to wonder, ‘Are we failing at setting up relationships with these patients who are sitting in the emergency department by using home health as a stop gap?’ These patients need the services and a relationship with a primary care provider to help keep them out of the hospital.”
The main takeaway from the study, Harris said, is that home health providers should be more proactive in educating their patients with the resources available to them in order to reduce unnecessary ED visits.
“Perhaps, it should even be required that home health providers assist patients with scheduling a PCP follow-up within 7 days of any ED visit if it is not already scheduled before discharge from the ED,” the study authors wrote. “Home health providers are oftentimes the first ones into the home and interacting with patients after ED visits. If it is required for home health providers to ensure a PCP follow-up is scheduled within 7 days of ED visit, there would likely be much fewer patients returning to the ED or hospital.”
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