Written By; Eric Quintin

Updated: January 2021

Blue Line= the number of total emergency department visits each month for CSP clients who are high utilizers (4 or more visits in the previous 90 days)

In November 2017 (pilot from August 2017 to October 2017), a team of Community Support Program staff (CSP) began an initiative to work collaboratively with Central Vermont Medical Center in reviewing Emergency Department utilization for CSP clients. This team began receiving information on individuals who were high utilizers of the Emergency Department (E.D.). A high utilizer was defined as having used the Emergency Department 4 or more times over the previous 90 days.  The team met monthly to analyse this data and see if they could devise any strategies that would lead to a decrease in E.D. usage.  The following strategies were employed:

1. Ongoing in Depth review of all CSP clients who are on the list, with each client individually reviewed and discussed.  

2. Multiple team members including our care navigator are now attending the monthly meeting at CVMC that includes providers from the community health team, home health, and other community providers and is focused on reviewing case of high E.D. users.  

3. CSP Case Managers were informed of the focus on high utilizers and asked to encourage clients to use either their medical provider or one of the different Urgent Care facilities instead.   Case Management Supervisors also suggested different strategies to help decrease E.D. use by individual high utilizers. Case managers are also asked to accompany the director to CVMC meetings when appropriate to enhance commnication and link them further with other external contributors.

4. The team categorized visits to the E.D. from the monthly report as either Medical, Psychiatric or unknown using the admitting diagnosis by the Emergency Department physician.

5. The team is sharing Crisis Plans and Care Plans with the E.D. on all high utilizers. 

6. The WCMHS CSP internal team continues to meet monthly to review E.D. use, reasons for the visits, and strategies to address the use.

Over the past 2 years, E.D. utilization for CSP clients has been reduced by 75%. Some of this can be attributed to success in significantly reducing the number of visits of the highest utilizer of the E.D., which has been attributed to assigning a new case manager who very quickly built a succesful alliance with the client and developed strategies to divert usage.  The access to monthly data reports on utilization along with the continued monthly meetings to review and develop strategies to divert utilization have also been contributing factors to the decreased usage.

• Central Vermont Medical Center
• Emergency rooms in the region
• CSP Case Managers
• Community Healthcare Providers
• CVHHH and SASH
• ONECARE VT

• Access to utlization data on a monthly basis
• Monthly meetings with E.D. staff and other providers to develop collaborate treatment plans
• Effective leadership and support of CSP case management staff to encourage focus on utilization and treatment planning that addresses diversion
• Senior and middle management committment to decreasing utlization
• Monthly meetings with CSP team to review data and develop strategies

• Multiple WCMHS clinicians will continue to attend monthly meeting at CVMC hosted by E.D. focused on high utilizers. 
• Continue internal CSP monthly meeting to review high utilizer list sent by CVMC to identify trends and review and develop individualized approaches to reduce inappropriate trips to E.D. 
• Continue tracking utilization rate, and change approach if necessary.