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How one hospital reduced avoidable ED visits—by telling patients 'I told you so'

by Petra Esseling

Better managing avoidable emergency department utilisation is a must-do strategy for every care transformation leader.

Patients visit the emergency department (ED) with primary care-treatable needs for a range of reasons. Sometimes education about the right site of care can get patients to choose a more appropriate treatment setting. But for those who choose the ED based on the incorrect assumption that it's always quicker and that the providers are more skilled, education often isn't enough.

One Spanish hospital developed an app to provide another means of directing such "convenience” patients away from the ED and into primary care. Here are two key takeaways from its experience:

1. Make wait time comparisons between the ED and alternate care sites readily available

Hospital de Torrevieja, a 270-bed hospital located in Spain, determined that 54% of its ED visits were for low urgency needs, which increased overall wait times.

Based on the assumption that many of these low-acuity patients were just looking for the most convenient site of care, the hospital created an online platform that allows patients to easily compare wait times between the general practitioner, the ED, and alternative options, such as a teleconsult. Patients can then use the platform to book appointments at their preferred site.

2. Use texts to remind patients that their GP may be the most convenient access point

After using the platform, many patients opted out of unnecessary emergency care—but some patients still made the trip to the ED for primary care services. For those patients, Hospital de Torrevieja's online platform automates a text message after the ED visit to let them know how much shorter their wait time would have been if they'd gone elsewhere.

Torrevieja calls these clever texts "I told you so” messages. It's the hospital's way of reminding patients, right when the memory of their long ED wait time is fresh in their minds, that it may be easier to see their GP next time.

The hospital's investment in the online platform has been worth its while. Today, only 17% of its ED presentations are low urgency—a staggering decline from its previous rate of 54%.

Get the behavioural health support your emergency department needs

Emergency departments are rarely equipped to meet the needs of patients with behavioural needs. That can lead to unnecessary admissions or mishandled treatment that exacerbates conditions.

Here are three ways you can help.

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