DorlandHealth

How an ED Countered Overuse

Three years ago Dr. Salvatore Vertaramo came up with an idea. As with most emergency departments, we had developed our own list of “frequent flyers.” Dr. Vertaramo, an ED physician, noticed there were in fact two lists of frequent flyers. The first were those who were very ill and frequented the ED related to their illness—for instance, those with congestive heart failure or cancer.

The second group frequented the ED for pain control. Realizing that an ED is not the most appropriate place for anyone to obtain pain control, Dr. Vertaramo came up with a plan to give this group a contract to lessen their narcotic use. Starting off by trying to convince fellow doctors and those in administration that this plan could work, he was met initially with a dose of skepticism. Even if the plan were effective, was it ethical? Was it even legal?

Dr. Vertaramo enlisted the help of our clinical information department to run a list of everyone who had visited the ED at least 10 times in the past year. He scoured every name and checked to see why they had come to the ED. He compared what medications had been administered both in the ED and by prescription for discharge. Equipped with this information, he took it to administration, where they decided that he could trial his idea for six months and see how it worked—provided it was greenlighted by our legal department, our patient advocates, and corporate compliance. The team identified the process for a contract, a referral list of pain and addiction centers, and options for chronic pain management. All contracts were individualized to target specific patients and their problems.

Best Practices in Telemanagement

The cost of managing chronic illness has become astronomical. Congestive heart failure is now a major chronic condition in the United States, with an estimated 5 million Americans living with the disease. The impact of heart failure and pulmonary hypertension is particularly severe among the elderly because of emotional and economic burdens like perpetual hospitalizations and functional decline, as well as lack of support systems, long-term medication therapy and depression.

In an effort to break an endless cycle of rehospitalizations and provide quality, cost-effective care, the Orlando Health Visiting Nurse Association (VNA), a hospital-based home health agency in Florida, piloted a Telehealth Disease Management Program in 2006 with 16 monitors. The evidence-based practice proved superior to other forms of practice in achieving better measurable outcomes. Thanks to Orlando Health hospital support, VNA now has 65 home telemonitors and has successfully improved patient outcomes and reduced cost while monitoring greater than 300 patients.