Emergency Department Triage for At Risk Populations

Project 2.b.iii Emergency Department Triage for At-Risk Populations

Alliance staff contact: Kristen Scholl | 518.701.2281

Objective: Develop an evidence-based care coordination and transition care program that will assist patients to link with a primary care physician/practitioner, support patient confidence in understanding self-management of personal health condition(s), improve provider to provider communication, and provide supportive assistance to transitioning members to the least restrictive environment.

Project Description: Emergency departments are often used by patients to receive non-urgent services for many reasons including convenience, lack of primary care physician, perceived lack of availability of primary care physician, perception of rapid care, perception of higher quality care and familiarity. This project will impact avoidable emergency department use, emphasizing the availability of the patient’s primary care physician/practitioner. This will be accomplished by making open access scheduling and extending hours, using electronic health records (EHRs), as well as making patient navigators available. The key to this project’s success will be to connect frequent emergency department users with the Patient-Centered Medical Home (PCMH) providers available to them.

Definition of Engaged Patient: The number of participating patients presenting to the emergency department who, after medical screening examination, were successfully redirected to a primary care provider as demonstrated by a scheduled appointment.

Project Requirements: 

  • Establish emergency department (ED) care triage program for at-risk populations.
  • Participating EDs will establish partnerships to community primary care providers with an emphasis on those that are PCMHs and have open access scheduling:
    • Achieve NCQA 2014 Level 3 Medical Home standards or NYS Advanced Primary Care Model standards by the end of DSRIP Year 3.
    • Develop process and procedures to establish connectivity between the emergency department and community primary care providers.
    • Ensure real time notification to a Health Home care manager as applicable”
  • For patients presenting with minor illnesses who do not have a primary care provider:
    • Patient navigators will assist the presenting patient to receive an immediate appointment with a primary care provider, after required medical screening examination, to validate a non-emergency need.
    • Patient navigator will assist the patient with identifying and accessing needed community support resources.
    • Patient navigator will assist the member in receiving a timely appointment with that provider’s office (for patients with a primary care provider).”
  • Established protocols allowing ED clinicians and first responders – under supervision of the ED practitioners – to transport patients with non-acute disorders to alternate care sites, including the PCMH to receive more appropriate level of care. (This requirement is optional.)
  • Use electronic health records (EHRs) and other technical platforms to track all patients engaged in the project.