Date of Doctor of Nursing Practice Project Completion
Summer 8-5-2025
Faculty Advisor
Rebecca Tsusaki PhD, APRN-CNP, WHNP-BC, IBCLC
Abstract
Date of Doctor of Nursing Practice Project Completion
Summer 8-5-2025
Faculty Advisor
Rebecca Tsusaki PhD, APRN-CNP, WHNP-BC, IBCLC
ABSTRACT
PURPOSE This quality improvement project was intended to decrease emergency department (ED) revisits by 10%, from high-utilizer patients (those with more than 10 ED visits in the past year), by implementing community health worker–led follow-up phone calls within one week of discharge, over a 30-day period. The project was conducted at a large metropolitan hospital in Houston, Texas.
BACKGROUND Non-urgent revisits and overutilization affect ED wait times, are associated with overcrowding, contribute to unnecessary care delays, impact patient satisfaction scores, and affect hospital reimbursements. High-quality care extends beyond the emergency department discharge instructions and collaboration with the case management department to provide community resources and follow-up phone calls to patients who revisit the ED, assisting with ensuring the best care is delivered.
METHODOLOGY The Plan-Do-Study-Act Framework was used to provide community resources and follow-up phone calls to patients who revisit the ED. A community health worker assessment tool was used to best meet the patient’s needs, and community resource sheets were distributed accordingly. Follow-up phone calls were provided after discharge from the ED.
RESULTS The project did not meet its goals. There was a 13% increase in ED revisits after intervention of follow-up phone calls. 36% of discharged patients were successfully contacted within one week via phone call. 1% of patients with substance use disorder were given a community resource packet of rehab/recovery centers.
IMPLICATIONS Collaboration with the community health worker was critical in the development of an assessment tool and the follow-up phone calls to the high-utilizer patient. The project leveraged the support of Community Health Workers (CHWs) to improve post-discharge communication, reinforce discharge instructions, and promote appropriate follow-up care. There is no single action, plan, or resource that will improve the overutilization in the ED. The success of this project will depend on interprofessional collaboration, which will require the utilization of numerous community resources.
Keywords
Emergency department revisits, non-urgent revisits, ED revisits, high utilizers, frequent flyers, case management, social worker, community health worker, community resource, follow-up
Recommended Citation
May, Amber RN, Decreasing Emergency Department (ED) Revisits: Providing Resources that Address Overutilization for Patients with Substance Use Disorder (2025). Doctor of Nursing Practice Final Project Abstract
Keywords
Emergency department revisits, non-urgent revisits, ED revisits, high utilizers, frequent flyers, case management, social worker, community health worker, community resource, follow-up
Recommended Citation
Amber May, "Decreasing Emergency Department (ED) Revisits: Providing Resources that Address Overutilization for Patients with Substance Use Disorder" (2025). Doctor of Nursing Practice Final Project Abstract. 94.
https://digitalcommons.library.tmc.edu/dnp_abstract/94