{'fraction_non_alphanumeric': 0.02442002442002442, 'fraction_numerical': 0.010175010175010175, 'mean_word_length': 5.009779951100245, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
PRACTITIONER APPLICATION: Reducing Preventable Emergency Department Utilization and Costs by Using Community Health Workers as Patient Navigators

Hospital emergency departments (EDs) across the United States are in crisis. Healthcare leaders must face the future by embracing opportunities to implement evidence-based practices and technologies to improve operational efficiencies. The authors of this article provide one example of an evidence-based practice in the use of patient navigators to manage a population of patients who often struggle to find a primary care provider or a place to receive an appropriate level of care. Applying a practice that works in the cancer care continuum to the ED to address barriers among nonurgent, nonemergent patients seeking healthcare, the authors demonstrate the business case for evidence-based practices in the ED. In 2009, Midland Memorial Hospital (MMH) implemented a telephone nurse triage (TNT) system, branded as 68NURSE, to provide our community with an alternative for patients who would otherwise use the ED as their first option for care. Studies conducted on the use of a TNT system showed that up to 72% of callers predisposed to visit the ED were triaged to a lower level of care (Fortune, 2001; Keatinge and Rawlings, 2005; Light, Hupcey, & Clark, 2005). This finding held true for callers to 68NURSE, and we saw an improvement in appropriate ED utilization. However, nonurgent, nonemergent patients continued to present to the ED. At about the same time MMH created 68NURSE, we established a medical screening exam (MSE) process, similar to that shown in the article’s Exhibit 1 up to the point at which patients are referred to a patient navigator. Under MSE, our nonurgent, nonemergent patients could pay a fee to stay in the ED and receive treatment or be discharged with a list of community resources to contact for care. I can see the value of adding a patient navigator to our process to improve the rates of appropriate ED utilization while providing patients with the care support they need (e.g., via urgent care clinics, primary care providers, home care, self-care). The authors have provided a solution to meeting the demands of patients who face barriers to accessing our current healthcare system. The results from this study offer a framework for action by other healthcare leaders, policy makers, and researchers as we seek ways to increase the appropriate utilization of our EDs.