Abstract
Society of Hospital Medicine – North Carolina Triangle Chapter Innovation Abstract
Development of Emergency Department Case Management Case-Finding Tool
David Gallagher1, Barbara Bentley2, Ashley Barry3, Marcia Moulton4, Amy Fracola5,
Lanie Dreibelbis6, Adam Glenn6, Katie Flanagan2
1: Duke University Hospital Medicine Programs 2: Duke University Hospital Case Management
3: Duke Health Technology Solutions 4: Duke Regional Hospital Case Management 5: Duke
Raleigh Hospital Case Management 6: Duke Health Performance Services
Background: Case Managers (CM) are now a standard support component of emergency departments
(ED) of large hospitals. They can help with improving quality and decreasing healthcare
utilization and costs. ED CM help ensure hospital admissions from EDs are appropriate
and if an alternative disposition for the patient exists, then they work towards that
goal. ED CMs are important to decrease friction and barriers to the correct care for
patients. ED CM responsibilities can include:
• Utilization management roles such as evaluating the appropriateness of admission
vs. observation vs. discharge
• Arranging alternative care destinations such as skilled nursing facility or assisted
living
• Organizing outpatient resources such as meals, home health care, durable medical
equipment
• Scheduling medical care follow-up
• Referring to support programs and social work for substance abuse, victims of violence,
psychiatric care, etc.
• Facilitating insurance coverage
• Securing housing
• Developing high utilizer or individual care plans
• Counseling patients and families
• Reviewing discharge instructions
The majority of ED CM find patients they need to intervene on by using a manual process
for case-finding which involves scanning multiple charts or relying on providers guiding
them on who to see. The INTERMED tool for case finding is the most common tool in
the literature but still represents a manual process that takes significant time.
Purpose: As part of our work on reducing readmissions at Duke University Health System
we hypothesized that the development of an automated tool for case finding would improve
efficiencies for CM, allowing them more time for interventions such as readmission
reduction strategies. Therefore, we developed an automated tool that stratifies patients
in ED based on variables agreed to by our expert consensus opinion.
Description: The tool resides in EPIC EMR ED track board in the CM tab. It is easily
seen in CM standard views and workflows. We chose 11 different demographic and utilization
variables and weighted them to create an overall CM Priority Score so that patients
who should be seen by ED CM would score high. CM Priority scores were color-coded
to indicate the need for CM support; red = high need, orange = medium, yellow = low,
green = none. CM can hover their cursor over the score to discover the variables driving
the score which may help with determining which interventions to apply. Four variables
were scored high enough to ensure that CM always saw these patients: ED consult order
for CM, potential readmission, complex care or behavioral concern flags, and hospice
enrolled.
Conclusions: The CM Priority Score tool went live 8/23/22 and we plan on assessing
its efficacy and reporting out at a future time. We are holding a rapid improvement
event to determine optimal interventions to pursue for patients with high scores in
addressing patient needs, readmissions risk, ED utilization, and resource allocation.