Date Available

7-23-2018

Year of Publication

2018

Degree Name

Doctor of Nursing Practice

Advisor

Dr. Judi Daniels

Committee Member

Dr. Karen Butler

Co-Director of Graduate Studies

Dr. Patricia Howard

Abstract

PURPOSE: High rates of emergency department (ED) use had little changes nationwide or in Kentucky after implementation of the Affordable Care Act. The Centers for Medicare and Medicaid Services have been calling for ways to reduce unnecessary ED usage. The purpose of this project is to identify factors associated with ED visits among adults in a primary care practice. The results are expected to serve as a needs assessment to determine ways for a primary care clinic to reduce inappropriate ED use.

METHODS A retrospective chart review was conducted to evaluate the ED use among 80 random selected adult patients who had at least one ED visit from January 1st, 2017 to June 30th, 2017. A total of 210 ED visits were reviewed. The patient demographic profile, ED presenting problems and acuity, and the ED visiting timing were evaluated. Correlations between the number of the ED visits and no-show/cancellation with PCP visits were studied as well.

RESULTS: The analysis found higher rates of ED use among middle-aged adults with public insurance, as well as Africa American adult, and women. The most common presenting problems were musculoskeletal or abdominal pain. Among 210 ED visits, 67% were ESI 3; 86% were discharged, and 59% were for the repeated presenting problems. Of 86% discharges, 56% did not see specialties or PCPs as directed. A significant and positive association was found between the number of no show/cancellations with their PCP and subsequent ED visits (r = .50, p < .001).

CONCLUSION: Increasing support to primary care practice may help reduce inappropriate ED use. Recommendations for the primary care practice are to: 1) assess patients’ self-care needs at every PCP visits, 2) educate patients on appropriate ED use, 3) make same or next day appointment available, 4) offer or coordinate non-business primary care.

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