Implementing a Medical Screening and Referral Program for Rural Emergency Departments

Authors

  • Terri L. Menser MBA,

    1. Department of Health Policy & Management, Center for Health Organization Transformation, Texas A&M Health Science Center, School of Public Health, Texas
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  • Tiffany A. Radcliff PhD,

    Corresponding author
    1. Department of Health Policy & Management, Center for Health Organization Transformation, Texas A&M Health Science Center, School of Public Health, Texas
    2. Department of Family Medicine, School of Medicine, University of Colorado Denver, Aurora, Colorado
    • For further information, contact: Tiffany A. Radcliff, PhD, Department of Health Policy & Management, School of Public Health, Texas A&M Health Science Center, 1266 TAMU, College Station, TX 77843-1266; e-mail: radcliff@tamhsc.edu.

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  • Kristin A. Schuller PhD

    1. Department of Health Policy & Management, Center for Health Organization Transformation, Texas A&M Health Science Center, School of Public Health, Texas
    2. School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota
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  • Disclosures: The health organization studied reviewed the content of this manuscript. However, all findings and opinions expressed are those of the author(s) and do not necessarily reflect the views of the funding source or organization studied.

  • Funding: This work was supported by the Center for Health Organization Transformation, funded by the National Science Foundation, Grant No. IIP-0832439. In addition, the health organization studied provided financial support to the Center for Health Organization Transformation.

  • Acknowledgments: The authors wish to acknowledge the helpful input of Florence Adewale, Charles (Taylor) Meyers, Nick Edwardson, Bita Kash, and Murray Côté.

Abstract

Context

Emergency Department (ED) overcrowding due to nonemergent use is an ongoing concern. In 2011, a regional health system that primarily serves rural communities in Texas instituted a new program to medically screen and refer nonemergent patients to nearby affiliated rural health clinics (RHCs).

Purpose

This formative evaluation describes the program goals, process, and early implementation experiences at 2 sites that adopted the program before wider implementation within the rural health system.

Methods

Primary data collection including document review, internal stakeholder interviews, and direct observation of program processes were used for this formative evaluation of program implementation in light of program goals and objectives. Fourteen key informants were asked questions related to the program concept, structure, and implementation.

Results

The program, as implemented, aligned with initial program goals, but it was dependent on ED screening staff and RHC availability. Some adjustments to the program were needed, including RHC hours, consistency among staff in making referrals, patient education, and improving patient uptake on the referral. Stakeholders reported lessons learned related to training, staff buy-in, Emergency Medical Treatment and Labor Act (EMTALA), and intraorganizational cooperation.

Discussion

The system was able to leverage excess capacity of affiliated RHCs to accommodate low-acuity patients referred from the ED and may lead to improvements in Triple Aim goals of increased patient satisfaction, better population health and outcomes, and lower per capita costs. Lessons learned from this program may inform similar processes aimed to reduce nonemergency ED utilization by other rural health systems.

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