Emergency Medicine

The Seven Best Practices

The goal of the Seven Best Practices program adopted by Washington and Oregon is to redirect care to the most appropriate settings, reduce low acuity, and reduce preventable Medicaid emergency-room visits. The plan, which focuses on high users, attempts to address the root of the problem—chronic medical conditions, substance-abuse issues, and lack of primary-care access—by leveraging the following components for success.

  1. Electronic Health Information— Adoption of an electronic emergency department information system on a statewide basis in order to create and act on a common, integrated plan of care related to patients with high needs (those who have logged five or more visits in a rolling calendar year). The plan of care would be adopted by all emergency rooms, payors, and mental-health clinics, and sent to primary-care providers.
  2. Patient Education—Dissemination of patient-education materials by hospitals and payors to help patients understand and utilize appropriate resources for care. This would include sharing information with patients and providers describing where patients can get off-hours coverage for primary or urgent care—including nurse call lines—and making this information easily available on provider web sites.
  3. Identifcation of Frequent Users of the Emergency Department and EMS—Frequent ER or EMS users are defined as those patients seen by or transported to the ER five or more times within the past 12 months. Hospitals should identify these frequent ER users upon arrival to the emergency department, and develop and coordinate case management— including utilization of care plans—to address any core issues documented in the statewide information system.
  4. Patient Care Plans for Frequent ER Users—A process to assist frequent ER users with their care plans through various means, such as contacting a patient’s primary-care provider within 72 to 96 hours and/or notifying that provider of an ER visit if no follow-up is required. Payors will provide the information system with the name(s) of the primary-care provider(s) or group for Medicaid patients, along with provider fax number(s).
  5. Narcotics Guidelines—Implementation of guidelines, incorporating existing Washington ACEP guidelines, to reduce drug-seeking and drug dispensation to frequent ER users.
  6. Prescription Monitoring—Enrollment of ER physicians in the state’s Prescription Monitoring Program (PMP). The PMP is an electronic online database used to collect data on patients who are prescribed controlled substances, ensuring coordination of prescription drug prescribing practices.
  7. Use of Feedback Information— Designation of hospital emergency department physicians and hospital staff who will be responsible for reviewing the reports of frequent ER users to ensure that interventions are working, including a process of reporting to executive leadership.

Updated January 2015.