Communication between LTC Providers and Emergency Departments Avoiding Unnecessary ER Transfers

Although the Centers for Medicare & Medicaid Services (CMS) has determined the use of Skilled Nursing Facility readmission data for Value Based Purchasing will be suppressed in FY 2023 due to the continuing effects of COVID-19 on the data, acute care facilities face payment reduction based on unplanned hospital readmissions under the Hospital Readmissions Reduction Program.  Payment considerations aside, procedures can be implemented to reduce unnecessary emergency department transfers from long-term care facilities which will ultimately improve patient care and satisfaction.

Duane Harrison, MD, provided an overview at the DRI Senior Living and Long-Term Care Seminar on how effective communication between emergency departments and LTC providers can impact patient care.  He reported that 86% of emergency department visits result in treatment and release, with the most common reasons for these visits being abdominal pain, acute upper respiratory infection, and non-specific chest pain.  He noted that the most common ED visits from LTC facilities are:

  • Injuries/falls (36%)
  • Heart conditions (19%)
  • Pneumonia (12%)
  • Mental status change, UTI, GI symptoms, fever, metabolic disturbances, skin disease (33%)

As described by Dr. Harrison, ED admissions have a negative impact on LTC residents, particularly those with cognitive issues and psychiatric diagnoses.  These patients often experience increased anxiety when moved from familiar surroundings.  Medical providers must incorporate these concerns when determining the appropriateness of transferring to the ED.

Effective communications include increased access to primary care providers in LTC facilities.  In addition, Dr. Harrison noted LTC facilities can utilize physician extenders, extended care paramedics, pharmacy providers, and therapy providers to assist with the evaluation of potential urgent or emergency issues.  A recent study revealed the use of alternative providers, particularly advanced practice registered nurses,  improved residents quality of care and lowered the number of hospital and emergency room transfers, ultimately saving one state $31 million in unnecessary ED admissions.  The long-term care medical team must consider the following when deciding to send a patient to the ED:

  • Clinical picture
  • Advance directives
  • Cognitive issues
  • Patient wishes

Appropriate and focused documentation provided to the ED staff is critical to efficiently evaluating and treating the patient.  Often the LTC facility provides voluminous medical record information which does not allow for a targeted plan and can result in needless testing and costs.  Dr. Harrison listed the information that should be made available to the ED staff:

  • Reason for transfer
  • Past medical history
  • Current medication and allergy list
  • Baseline mental & functional status
  • Advance directive wishes
  • Contact information for a healthcare provider at the LTC facility
  • Contact information for a PCP
  • Recent set of vitals

It is useful for hospitals to share protocols with LTC facilities to proactively manage transfers or readmissions.  Telehealth can also play a key role in evaluating a patient while they are still at the LTC facility by improving access to care.  Also, new programs, such as ED in Home, are facilitating diagnostics and some treatments where the patient lives to avoid the stress, and expense, of a visit to the emergency room.

Accurate and complete documentation in the medical record, whether in paper or electronic format, is critical to appropriate and high-quality care.  This is underscored when the patient has dementia or other cognitive issues and lacks communication skills.  Further, accurate, complete, and timely documentation is a key in reimbursement, compliance, and risk management.

Excelas has experience and expertise in managing medical information to assist long-term care facilities in developing/improving comprehensive documentation programs and in assisting counsel in efficiently handling health data for potential claims and litigation.  Contact us today to discuss your medical information management requirements.

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