Touchstone Silver: Clinic Walk-In Hours Increase Access, Reduce ED Visits

Reliance on emergency departments for treatment of more routine medical problems can be costly and increase wait times. Pediatric patients insured by Medicaid visit emergency departments at higher rates than the uninsured or those with private insurance. The most common diagnoses in children seeking care in an emergency setting are upper respiratory infections, fever and ear infections.

The New Hanover Regional Medical Center - Coastal Family Medicine clinic cares for many area children insured by Medicaid and has seen increases in its pediatric patients. Over a one-year period, 95 percent of Coastal Family patients who visited the emergency department were treated and released without hospitalization. Over the same period, the clinic found that 97 percent of its patients visiting the emergency department were insured by Medicaid.

The project

Coastal Family Medicine wanted to help families avoid trips to an emergency department when their child’s condition could be treated by their regular doctor. After consulting with families that had taken their children for emergency care, the clinic launched 8 a.m. to 5 p.m. walk-in hours Monday through Friday for all patients under 18.

Physicians, front-desk staff and even after-hours on-call services were all encouraged to mention the walk-in hours to patients, and the clinic included the hours on bookmarks with books distributed to young children. Walk-in hours were later expanded to include adult patients. To help accommodate walk-in demand, physicians whose patients didn’t show at appointments would instead see a walk-in patient.

The impact

One year after launching the walk-in pediatrics hours, the clinic saw a 30 percent reduction in pediatric emergency department visits.

The success was also evident in the clinic’s pediatric rate for emergency department use, which fell from 71.5 visits per 100 patients a year to 41.9, below the national rate of 45.5 visits.

“By optimizing the setting in which these patients were seen, we improved continuity, decreased unnecessary burden on our emergency room, and saved Medicaid over $300,000 in 12 months,” said Dr. Toren Davis, medical director and faculty physician at Coastal Family.

The effort earned a 2018 Silver Touchstone Award from Atrium Health, which is affiliated with NHRMC. The awards recognize projects that achieve the greatest level of improvement and demonstrate a best practice in patient safety, clinical outcomes, clinical efficiency and patient experience. NHRMC earned seven Touchstone Awards in 2018.

Team members