A Multidisciplinary Effort to Reduce ED Utilization & Workplace Violence

On December 4th, Gina Sulmeyer, MD and David Presser, MD, MPH from Torrance Memorial Medical Center presented a webinar through Becker’s Hospital Review titled “Collaboration: The Key to Optimizing ED Utilization, Tracking, and Workplace Safety in the Hospital Care Setting.” 

In this webinar, Drs. Sulmeyer and Presser shared how Torrance Memorial has been able to streamline care for patients with high emergency department (ED) utilization, substance use disorders (SUDs), and those with histories of violent incidents—resulting in a median reduction in visits-per-month of 52 percent for patients with complex needs.

In 2018, a multidisciplinary committee formed with representation from physicians, nurses, social workers, case managers, floor leads, and administration. Torrance Memorial’s legal and security teams became vital to the committee after security incidents in late 2018 and early 2019.

Creating Actionable Care Plans

During meetings, committee members decided on actionable care plans for vulnerable patients referred by ED nurses, social workers, hospitalists, and even accountable care organization (ACO) directors.

Quickly, three main types of care plans emerged—focusing on patients with chronic pain and/or SUDs, mental health conditions, or past disruptive or violent behavior. Noticing this pattern allowed committee members to develop flexible, ‘a la carte’ care plans that could be modified and customized for each patient referred to the committee—saving time while still helping each patient.

The Impact on Workplace Violence

Drs. Presser and Sulmeyer conveyed the impact these care plans had on hospital staff, particularly in regards to workplace violence. Torrance Memorial was able to develop both security and medical protocols for patients with a history of disruptive or violent behaviors—leaving staff feeling safer and more confident at work.

When a patient with a history of violence registers at the ED, the Director of Security is automatically notified via text or phone call. Security staff then guide the patient to a designated evaluation area, screen them for weapons, and remain with the patient throughout their visit. The medical protocol for these patients prioritizes a speedy throughput, complex evaluations to be done in highly visible areas, and a security escort off premises if necessary.

At the same time the protocols were being developed, lead nurses were trained to identify patients with threats of workplace violence and alert staff at registration. Dr. Presser shared that this redundant identification technique improves the likelihood of successfully alerting staff before any incident occurs.

Outcomes & Future Developments

It didn’t take long before this collaborative group got a reputation as the “little committee that could.” Dr. Presser commented that they knew they had made it after receiving official recognition as a subcommittee of the ED. He also joked that they knew they had made it once they were able to get food at their meetings—a victory for anyone who has tried to accomplish that.

In addition to receiving positive attention from hospital staff and administrative, there have been quantifiable successes from the efforts of this initiative. Committee members have helped reduce monthly visits by 52 percent due to implementing carefully coordinated care plans.

Currently, Torrance Memorial is brainstorming ways to best target patients that haven’t responded well to intervention. They’re working with case managers at ACOs, staff at Torrance Memorial’s Care Coordination Center, and insurance case managers for out-of-network patients.

Going forward, this multidisciplinary committee is looking to generate more robust reports and enhance security notifications to continue helping patients with patterns of high utilization or histories of violent behavior.

To learn more about Torrance Memorial’s efforts, you can view a recording of the webinar here.