In St. Louis, a woman who struggled with heart disease sometimes had so much trouble managing her breathing that she couldn't even take out the trash. When that happened, she did what many Americans do: She called 911.
Christian Hospital began working with her via the paramedics who visited her home whenever she called for help. When the community provider, just outside St. Louis, conducted its initial assessment, providers realized she needed ongoing care and a solid plan, including education and working with her primary care physician, to help stabilize her breathing.
Jennifer Cordia, Christian Hospital’s chief nurse executive and vice president of patient care services, says the patient called the hospital recently to let staff know how well she was doing. She’s now able to leave her house, walk comfortably — and take out her own garbage.
“She just went to her first Cardinals baseball game,” Cordia says. “She was so excited. She had never been to one.”
Many hospitals like Christian struggle with overutilization of their emergency departments. Often, underinsured or uninsured patients use these services as de facto primary care. After taking a closer look at the numbers, the hospital discovered that 48 percent of its ED visits and 40 percent of emergency medical services visits were nonemergent — that is, nonacute situations that would have been better handled in an office setting. Hospital officials were determined to find a solution.
“We really got a team of people together and identified the problem. We realized quickly that we needed to provide the right care, at the right cost, at the right place,” says Cordia. “The right place was our first focus.”
That was in summer 2013. The team began to work with the 911 dispatcher to identify patients who needed something other than the emergency care that 911 provides. By training community paramedics to assess patients, they were able to navigate those patients to what they called an access center. In early 2014, they opened two such centers, with coordinators who could help provide the type of care that patients needed.
“What we realized is that we needed to understand why patients were coming to the ED in the first place,” says Cordia. “So we asked them, individually.” What they found was that people generally weren’t using community resources that already existed and were funded — and sometimes the reason was that they simply didn’t know those resources existed.
Cordia emphasizes that access coordinators do more than simply point people to those assets. “Our access coordinators have made and cultivated relationships with community resources in the past three years,” she says. “We literally walk with the patient as we help them get through the barriers to access care.”
The Community Health Access Program that formed as a result of Christian Hospital’s efforts has transformed the lives of many patients. In the three years since starting CHAP, Christian Hospital has connected more than 9,000 patients to needed resources.
Most recently the hospital has focused its efforts on patients who are high utilizers of the 911 system and the ED, like the aforementioned Cardinals fan, helping them get the care they need. Another CHAP patient, Shirlie Anderson, has congestive heart failure that landed her in the ED several times. She says of her experience: “They were excellent, very helpful, very cheerful. Just awesome.”
The team would come to Anderson's home once a week and take her vitals. She says they helped her tweak the timing of a medication she takes to regulate her blood pressure, which is now under much better control, allowing her to continue to stay out of the ED. “They said, ‘Shirlie, take the medication as soon as you know your blood pressure is up.’ To this day I couldn’t tell you why I was waiting.” For her, this simple adjustment made all the difference.