A coalition that has been working for several years to reduce preventable emergency room visits in Washington state claims it has improved utilization and quality of care, and created savings, while also drawing national attention for its efforts.

The coalition, a public-private partnership that’s operating under the name ER for Emergencies, said earlier this year that it recently had adopted phase two of its Seven Best Practices program to reduce avoidable emergency room visits, integrating critical narcotic-prescribing information with electronic medical records in emergency departments across the state. 

The ER is for Emergencies coalition includes the Washington State Medical Association, Washington State Hospital Association, the Washington Chapter of the American College of Emergency Physicians and the Washington State Health Care Authority.  

 The ER is for Emergencies campaign attempts to address the root causes of emergency room overuse—including chronic medical conditions, substance abuse issues and lack of primary care access—through a multipronged approach.

That approach includes focusing on frequent users, using targeted strategies such as patient education, improving access to primary care and encouraging physician participation in the state’s Prescription Monitoring Program, which tracks data on patients who are prescribed controlled substances.

Coalition partners claim that Washington is the first state in the nation to integrate information from the Prescription Monitoring Program into the electronic medical records of an emergency department. This critical information enables physicians to know which drugs the patient has been prescribed, they say, and can help prevent an emergency department from prescribing medications that may contribute to drug interactions or overdoses. 

Since 2012, ER is for Emergencies coalition has released two reports showing its success. The most recent report, for fiscal year 2013, showed that the rate of emergency department visits declined by 9.9 percent, the rate of “frequent visitors”—those who make five or more visits annually—dropped by 10.7 percent, and the rate of visits resulting in a scheduled drug prescription fell by 24 percent. It also showed that the rate of visits with a low-acuity, or less serious, diagnosis decreased by 14.2 percent, and that there had been a savings of $33.6 million in Medicaid fee-for-service emergency care costs.

Improving access to health care for the citizens of Washington includes directing them to the most appropriate and most cost-effective place to receive care, whether it’s a primary care office, urgent care center or emergency department, the coalition says. Reducing preventable emergency room visits benefits everyone—patients, physicians, hospitals and the state budget, it says. 

 The seven “best practices” adopted by the coalition are as follows:

 *Adopt a statewide electronic health information system to coordinate care plans of patients with high needs — again, referring to those who make five or more visits to emergency rooms annually — with emergency rooms, payers, mental health clinics and primary care providers.

*Disseminate patient education materials to help patients understand appropriate resources for care.

*Identify frequent users of the emergency department and emergency medical services and develop and coordinate case management, including utilization of care plans.

*Develop patient care plans for frequent ER users.

*Reduce drug seeking and drug dispensing to frequent ER users.

*Encourage emergency physician enrollment in the state’s Prescription Monitoring Program to ensure coordination of prescription drug prescribing practices.

*Use feedback information to review reports of frequent ER users to ensure interventions are working. 

All of the coalition partners are key representatives of health care providers or purchasers in the state.

The Washington State Medical Association represents physicians and physician assistants throughout the state. Its vision is to make Washington the best place to practice medicine and to receive care. For more information about the WSMA go to wsma.org. 

The Washington State Hospital Association represents all of Washington’s 99 community hospitals. The association takes a leadership role in issues that affect delivery, quality, accessibility, affordability and continuity of health care. It works to improve the health status of the residents of Washington state. WSHA is online at wsha.org.