Sturdy Memorial Hospital is a small, independent hospital in southeast Massachusetts, and it is the only hospital in the region that is completely unaffiliated with any other hospital.

THE PROBLEM

Partly because of this, finding inpatient psychiatric beds – or funding to assist with expanding care for behavioral health patients – is particularly challenging. The emergency department has 32 beds, but the provider organization sees approximately 49,000 patients every year.

“Many of the patients we see with high patterns of ED utilization are struggling with behavioral health conditions,” said Dr. Brian Patel, chief emergency services and associate chief quality officer at Sturdy Memorial Hospital. “The boarding of behavioral health patients is one of our biggest issues at Sturdy. We’re trying to address ways to minimize ED boarding for these patients and it began with taking the time to stop and really study these patients, evaluate their length of stay and dispositions, analyze their reasons for presentation, and develop a plan for reducing ED utilization.”

The process for these patients looked something like this: Patients who present at the ED are seen in the ED, cleared by a provider, and then evaluated by a behavioral health clinician. ED physicians then work in tandem with those clinicians to review the patient needs and history and create an appropriate care plan for the patient moving forward.

"It’s been incredibly helpful to not only get the contact info for these key members of the care team, but also to have a way to push critical patient information to these providers so they can effectively reach out to their patient and provide the best care possible."

Dr. Brian Patel, Sturdy Memorial Hospital

“But this takes time,” Patel noted. “And with limited time, limited inpatient psychiatric beds and resources, and monetary resources available to us, establishing a program that effectively cares for behavioral health populations was proving difficult. We needed to look at ways to better connect our patients to appropriate outpatient resources so they could be better cared for outside of the emergency department and hopefully prevent the need for inpatient psychiatric care.”

PROPOSAL

Sturdy Memorial Hospital needed a way to connect its behavioral health patients coming in through the ED with better resources that were actually equipped to support the patient. So the hospital turned to care collaboration IT vendor Collective Medical to gain greater insight into these patients.

“The Collective platform connects every member on a patient’s care team so physicians, nurses, clinicians, etc., can collaborate on care plans and have real-time access to patient histories and past encounters,” Patel explained. “It helps us all stay on the same page so we can coordinate consistent, quality care and facilitate seamless care transitions between care settings.”

Because of the hospital’s high volume of patients in the ED, it was impossible to know the history of every patient. But the IT platform pushes all of this valuable information directly to staff at the point of care. It takes a lot of the guesswork out of caregivers’ jobs and significantly reduces the time care providers would have to spend searching for this information, Patel said.

“The platform also informs us of what hospitals the patients are presenting to,” he added. “Then care managers can attempt to connect with these patients at these key times and work with them to better understand why they present to the ED and determine ways to assist patients with seeking alternative forms of care when they need it in the future.”

Many of these patients are very difficult to connect with outside of the hospital. This technology lets the patients’ caregivers know when the patient presents to an ED, which is the perfect, and often only, opportunity to meet with the patient and work to better coordinate their care, he said. Without this platform, many of these patients are lost to follow-up by their care managers because they simply do not know where their patients are, he added.

MARKETPLACE

There are a variety of care collaboration platforms on the health IT market today. Some of the vendors of these platforms include Carestream, Careteam, DrFirst, eXo Platform, PerfectServe and Wipro.

MEETING THE CHALLENGE

With the information provided by the Collective platform, staff worked with a behavioral health clinical group to identify behavioral health patients with more than three ED visits in six months. And this does not mean three ED visits to Sturdy, it means three ED visits to any ED.

“This group was working through a Massachusetts ACO to help better manage their patient population,” Patel said. “We worked together to identify common high-utilizer patients who were assigned to outpatient programs with a dedicated case manager who was qualified to help the patient manage their behavioral health and social issues long-term and outside the ED.”

Information about the patient – including up-to-date and accurate name and contact information for the patient and case manager assigned to the patient – are recorded in the platform, and notifications are programmed to automatically alert ED providers when these patients present in the ED.

“Because of these real-time alerts at the point of care, busy ED staff have a far easier time ensuring smoother care transitions between key providers and care settings,” Patel noted. “When these patients presented to the ED, the ED staff would contact the care manager, who would often come to the ED to connect with the patient and assist with management.”

A lot of managing behavioral health comes down to the coordination of care and making sure that case managers are aware when their patients present to the ED or to the hospital.

“But the reality is, making that happen is challenging when we don’t have insight into basic information like case manager info,” Patel said. “It’s been incredibly helpful to not only get the contact info for these key members of the care team, but also to have a way to push critical patient information to these providers so they can effectively reach out to their patient and provide the best care possible.”

And, ultimately, coordinating with case managers has helped Sturdy reduce unnecessary ED utilization and provide better care for behavioral health patients, he added.

RESULTS

“By contacting the right case manager when a behavioral health patient presents at the ED, coordinating with case managers, and transitioning the patient to appropriate care in an outpatient setting, we’ve been able to reduce the number of visits from these patients in the ED,” Patel reported.

The program still is growing and taking on new use-cases, but the results the hospital has seen so far are promising.

“In the initial pilot, Sturdy reduced unnecessary ED utilization by enrolled behavioral health patients from 31 visits in a six-month period to just seven: That is a 78% reduction in six months,” Patel said. “This reduction means that more patients are getting the best behavioral health care they could – in channels designed to help them – while maintaining an affordable cost of care.”

Additionally, with some patients, Sturdy has seen a significant reduction in length of stay in the ED. One patient’s length of stay decreased from 6-7 hours down to less than an hour.

ADVICE FOR OTHERS

“For anyone hoping to improve behavioral care, the time and energy that goes into implementing and maintaining a similar care collaboration program might seem daunting, but I’m here to tell you it’s worth the effort,” Patel advised.

The money and time it took to set up preventative initiatives like Sturdy’s behavioral health program was significantly less than it would have taken to treat these patients who would have otherwise kept coming back to the ED, he stated.

“And many of these visits would not have been compensated or reimbursed,” he noted. “And the ED is not an appropriate channel to provide the long-term help these patients need. If you do not have the resources – and behavioral health resources are slim – you need to work smarter with what resources you do have available. Trust me, the effects have been transformative.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com
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