Development of Emergency Department Case Management Case-Finding Tool

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.