Kaiser Permanente Northwest takes new approach to redirect ER superusers

It’s a dilemma that nearly all hospital emergency rooms face. How to cut down on the number of “frequent fliers” or “superusers” who seek routine care in the emergency department instead of less costly settings.

In many cases superuser patients face non-medical problems with housing, food insecurity and lack of transportation.

Kaiser Permanente Northwest’s new strategy is to station “navigators” within the ER to engage with these superuser patients to find out what they need and connect them to more appropriate community resources. And so far, according to the Portland Business Journal, it’s paid off.

Readmissions to the emergency room have dropped 55 percent among the 254 patients that navigators are managing, according to the publication. Furthermore, the hospital reports a 38 percent drop in hospital admissions and a 30 percent decline in the number of days the patients stay in the hospital.

“ED use is a measure of upstream challenges these patients have, one of the markers for it,” Briar Ertz-Berger, M.D., the ED doctor who led the intensive case management pilot at Kaiser, told the publication. “They have behavioral health issues and a lot of chronic pain and social challenges. They are frequently no shows to primary care providers. They have difficulty accessing ambulatory care.”

Other hospitals have also had success with navigators reducing superuser patients’ reliance on the ED.  A 2015 pilot program conducted by the Highmark Foundation and Accenture that used navigators at three western Pennsylvania hospitals reported a 43 percent reduction in non-emergency use of the emergency room, and a 60 percent reduction in 30-day readmissions for targeted diagnosis-related groups.

The navigators conducted patient follow-ups, connected patients to local care services and scheduled physician appointments. The feedback was also positive. Physicians had more time to handle more acute cases and the patients, “felt as though they found friends, people that were like them," David Balderson, who heads Accenture's patient navigation program, previously told FierceHealthcare.

- read the Portland Business Journal article