O2130: Reducing Nationwide Children’s Hospital Primary Care Network Emergency Department Utilization Through Quality Improvement

Purpose/Objectives: To employ quality improvement (QI) methodology in reducing Nationwide Children's Hospital (NCH) Primary Care Network (PCN) patient attributed visits to emergency department (ED) from 21.0 ED visits per 1000 patients to 15.0 by December 31, 2022 and continuously improve.

Design/Methods: QI-implemented interventions included: establishing Same Day Sick (SDS) clinics in PCN, increasing access to sick appointments on Saturdays, identifying patients that frequently utilize ED, sending patient portal EMR messages, increasing utilization of the nurse triage line through a “Call Us First” campaign, increasing primary care physician (PCP) continuity of care, partnering with school-based and mobile community clinics, and deploying a focused marketing campaign (Figure 1). Statistical process control methodology was used, and a control chart was used to display monthly data for the network.

Results: The baseline ED visit rate (January 2016-April 2017) was 21 ED visits per 1000 NCH PCN patients (Figure 2). After PCP continuity of care expansion took place in April of 2017, we noted a decrease and centerline shift to 17. Four same-day sick locations were added from October 2017-November 2019, and the “Call Us First” campaign started in November 2018. The next centerline shift to 8 started in June 2020, following the beginning of the COVID-19 pandemic. Numbers increased over several months, and there was another centerline shift to 15 starting May 2021. We started sending messages in June of 2021 via the patient portal to families who visited the ED.

Conclusion/Discussion: We were able to successfully implement several QI interventions that correlated with a reduction in ED utilization from a baseline of 21 ED visits per 1000 NCH PCN patients to 15 in May 2021, which was maintained thru October of 2022. Outside factors including the COVID-19 pandemic and associated stay-at-home restrictions likely also had some impact on this QI project. However, even following the expected increase in utilization following the lifting of restrictions, we were able to maintain our overall reduction in ED utilization from our baseline rate. We were able to reduce ED utilization by over 6,600 visits in 2022. Further quality improvement studies are needed to help reduce ED utilization in the Medicaid population.