ACEP Cost Containment Survey

Introduction

  
Thank you for agreeing to participate in the ACEP Cost Effective Care survey. As you know there is increasing pressure to reduce the cost of healthcare. ACEP has convened the Cost Effective Care Task Force to identify evidence-based best practices in Emergency Medicine that can reduce the cost of care without sacrificing the quality of care. We know there are opportunities to reduce cost in emergency care-- but we need your help.
 
This survey aims to identify practices that we can change in the ED to improve affordability without sacrificing the quality of emergency care. This is an idea generation survey that will guide ACEP's future direction on this subject. Therefore, we need, and greatly appreciate, your submission of any relevant ED action, test, procedure or process that you think might apply. As a result, we seek your input as a front-line ED provider to identify emergency care practices that are of high value and underutilized, or that are low-value and high cost. While not required, if possible, please provide evidence supporting your suggestions (such as references to medical literature, quality measures promulgated by the National Quality Forum, data internal to your EM group or hospital, or other comparable sources). Your responses will be used by the Task Force to develop a list of priorities for improving the value of care delivered in Emergency Departments. We will review each suggestion with a group of practicing clinicians and content experts.
 
We look forward to sharing the results with the ACEP community in the future.
 
Sincerely,
ACEP Cost Effective Care Task Force
  

Chair David W. Ross, DO, FACEP drdr0682@aol.com Representatives Dennis M. Beck, MD, FACEP dbeck@beacon-medical.com Stephen V. Cantrill, MD, FACEP stephen.cantrill@dhha.org Deborah B. Diercks, MD, FACEP dbdiercks@ucdavis.edu Michael A Granovsky, MD, FACEP gwep911@cox.net Charles R. Grassie, MD, JD, FACEP cgrassie@epmgpc.com Ronald A. Hellstern, MD, FACEP rahellstern@gmail.com William P. Jaquis, MD, FACEP wjaquis@lifebridgehealth.org Chadd Kraus, DO, MPH chaddkraus@hotmail.com Bret Nicks, MD, FACEP bnicks@wakehealth.edu Jesse Pines, MD, MBA, FACEP jesse.pines@gmail.com Nathan Schlicher, MD, JD schlicnr@yahoo.com Jeremiah D. Schuur, MD, FACEP jschuur@partners.org William P. Sullivan, DO, JD, FACEP wps013@gmail.com Dylan Carney | MD MPH Candidate 2013 dylancarney@gmail.com

Thomas E. Syzek, MD, FACEP tsyzek@phcsday.com Vivek S. Tayal, MD. FACEP vtayal@carolinas.org Board Liaison Michael J. Gerardi, MD, FACEP mgerardi@acep.org Board Members Andrew Sama, MD, FACEP asama@nshs.edu Sandra M. Schneider, MD, FACEP sandra_schneider@urmc.rochester.edu David C. Seaberg, MD, FACEP dseaberg@uthsc.edu Staff Liaison Marilyn Bromley, RN mbromley@acep.org Emergency Medicine Practice Director 800.798.1822, Ext. 3234 972.550.0911, Ext. 3234 Additional Staff Laura Gore lgore@acep.org Public Relations Director Stacie Jones sjones@acep.org Quality Measures/HIT Director Gordon Wheeler gwheeler@acep.org Associate Executive Director Dean Wilkerson, JD, MBA, CAE dwilkerson@acep.org Executive Director

 

 

ACEP Cost Containment Survey

Survey Questions

 
This survey asks you to identify specific actions clinicians or EDs can take without affecting quality of care -- potential changes to your practice including ordering diagnostic tests (labs, diagnostic imaging), treatments (e.g. medications and blood products), disposition decisions (e.g. admission or discharge, and follow-up) or other actions (e.g. if patient volume dictates the use of testing ordered in triage - set up strict, monitored protocols; setting up care plans for frequent ED users, alternate destinations for patients besides an ED).
 
Please list as many ideas as you wish in the box in question # 1. You may submit as many responses to this survey as you like. Please be as specific as possible regarding the action by identifying the circumstances in which the action should be used or avoided. If known, please provide at least 1 published reference for your idea in the box in question #2. However, a citation is not required. Please provide your idea even if there is no available citation for it.
 
Examples:
 

Diagnostic Testing

Description of action: Don’t order serum amylase to diagnose acute pancreatitis in adults when serum lipase is available. Applicable population inclusion criteria: ED patients where pancreatitis is a clinical concern. Applicable population exclusion criteria: None. Rationale: Lipase has been shown to be more sensitive and specific for the diagnosis of pancreatitis. Supporting evidence (reference/PMID): 11552931.

Treatment

Description of action: Don’t prescribe antibiotics to adult patients with acute bronchitis. Applicable population inclusion criteria: ED patients with acute bronchitis. Applicable population exclusion criteria: Patients with comorbidities including chronic bronchitis, patients on antibiotics within the prior 30 days. Rationale: Acute bronchitis is usually a viral process and antibiotic treatment does not hasten time to recovery but can lead to antimicrobial resistance. Supporting evidence (reference/PMID): National Quality Forum-endorsed measure 0058.

Disposition

Description of action: Treat patients with uncomplicated deep venous thrombosis (DVT) as outpatients. Applicable population inclusion criteria: Adults with available medical followup. Applicable population exclusion criteria: Complicated DVT (e.g. phlegmasia cerulea dolens), inability to obtain outpatient anticoagulation medication or administer medication. Rationale: DVT can be safely treated in the outpatient setting at lower cost and patients prefer to avoid hospital admission. Supporting evidence (reference/PMID): http://archive.ahrq.gov/clinic/epcsums/dvtsum.htm

Miscellaneous

Description of action: Each ED should create a care plan for at least one super-user (e.g. >10 visits per year) and coordinate needed services for this plan. Applicable population inclusion criteria: >10 visits in any 365 day period Applicable population exclusion criteria: None. Rationale: Super-users of the ED accumulate high costs to the system and frequently have specific needs such as substance abuse and social supports that routine emergency care is ill-equipped to address. Supporting evidence (reference/PMID): 19417194.