Care Coordination in the ED: Nurturing a Continuum without Boundaries

Added on Oct 2, 2014

Emergency medicine plays a vital role in the health care continuum in the United States. Breakthroughs in medical science and greater use of health care services are helping people to live longer, but they are also getting sicker as they get older. At the same time, the diminishing availability of primary care physicians and the increase in the number of insured individuals are driving changes in emergency department (ED) utilization. 

These considerations have contributed to a health care crisis that can be alleviated in part by improving care coordination, both systemwide and within the ED. In fact, the ED is a critical focal point for coordinating care. 

Given the aging population, the growing number of individuals living with chronic disease, and the increasing population of patients that do not have access to primary care, it is not uncommon for patients who present to the ED to have complex health issues that will require care well beyond the ED, whether they are admitted to the hospital or not. Further, when these patients present to the ED, their visits tend to be more intense and time-consuming than average. Without coordination and collaboration between providers, health care settings, and patients and their families, these patients are destined to return to the ED. 

Not only is care coordination a best practice for achieving optimal clinical outcomes, our research shows that it is important to patients. They want their care to be well coordinated, and they also want to be a part of that coordination to ensure that health care entities are communicating about their care. In fact, showing patients that the relationship doesn’t end when they are not directly in contact deepens the relationship and improves the perception of care. Patients who perceive a better experience also report better outcomes. 

For this reason, strategies for care coordination must extend to the ED. Examples include post-discharge phone calls, discussing the care plan and results with the patient during the visit, instilling confidence in the health care team by managing each other up to the patient, explaining to the patient how communication about their care is happening and what they can expect, providing home-care instructions that are clear and in a language the patient and family can understand, using the teach back method to ensure the information the patient needs for post-discharge success is the information they’ve heard and have the capacity to follow through. 

When integrated into the ED care-delivery process, these activities help align pre-, intra- and post-ED care so that information flows throughout the continuum rather than only within the silo of the ED. 

Care coordination is not about managing one visit to the ED. Rather, it encompasses the entire health care continuum for each patient and all of the providers that care for them.