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VA research in action
Emergency Department Patient-Aligned Care Team (ED-PACT) Transfer Tool
November 7, 2018
Most patients who visit hospital emergency departments (EDs), including VA EDs, are not admitted to the hospital following their visits. Studies have shown many patients who are treated and released from an ED are vulnerable for adverse outcomes. Between five and 19 percent of those patients return to an emergency department within 30 days—and a Canadian study found that 1 percent of senior citizens treated and released from emergency departments died within 30 days of their visits and 5 percent were hospitalized.
Another problem with “treat and release” is that many patients don’t understand what they are told about their condition when they are discharged. A different study showed that 15 percent did not understand the diagnosis they were given; 29 percent did not understand the care they were provided; 34 percent did not understand the instructions they were given to care for their illness or injury; and 22 percent did not understand when, or to whom, they were supposed to return for additional care. As a result, many patients did not get the follow-up care they needed, became more ill, and made unnecessary return visits to the ED.
To address this problem, researchers at the VA Greater Los Angeles Healthcare System (GLA) have developed a tool using VA’s electronic health record system to enable emergency care clinicians to send messages to Veterans’ primary care Patient Aligned Care (PACT) team nurse care managers on follow-up needed for Veterans with urgent or specific needs after an ED visit. PACT teams are partnerships between Veterans and their health care team to ensure they receive whole person care. Members of PACT teams include the Veteran, caregivers, primary care providers, nurse care managers, clinical associates, and administrative clerks.
The tool allows PACT team managers to arrange needed follow-up care for Veterans who have visited EDs, so the Veterans themselves do not need to do so. It reduces the need for repeat visits to the ED and for hospitalizations. Since 2016, the tool has facilitated more than 5,500 ED-to-PACT transitions for Veterans treated at GLA. It has been explained to VA caregivers nationwide for their consideration and possible use.
Principal investigator: Dr. Kristina Cordasco, VA Greater Los Angeles Health Care System
Rubenstein LV, Stockdale SE, Sapir N, Altman L, Dresselhaus T, Salem-Schatz S, Viveli S, Overetveit J, Hamilton AB, Yano EM. A patient-centered primary care practice approach using evidence-based quality improvement: rationale, methods, and early assessment of implementation. J Gen Intern Med, 2014 Jul;29 Suppl 2:S589-97.
The ED-PACT Tool: Communicating Veterans’ Care Needs After ED Visits, VA Research Seminar, Dec. 20, 2017