230 Reduction in Emergency Department Visits After Implementing a Care Plan in Patients With Drug-Seeking Behavior: Five-Year Analysis

Abstract

Patients with drug seeking behavior can be both labor and resource-intensive to the emergency department (ED). We determined the change in number of ED visits for five consecutive years following a care plan initiation for individuals who displayed drug seeking behavior. A retrospective, cohort observational study. Location: a suburban teaching hospital with an annual census of 80,000 patients. A care plan was initiated for patients flagged by ED staff as concerning for drug-seeking behavior. An ED administrator then collaborated with the patient’s primary doctor. If the primary doctor concurred, a plan of care was initiated, which typically restricted narcotic administration. Patients subsequently received a certified letter regarding their plan. Copies of the letters were placed alphabetically by name in binders residing in the ED, and charts were flagged when patients presented to the ED. The first 20 patients in each of 3 binders were included in the study population (N=60). The numbers of ED visits were determined one year prior, and for five consecutive years following care plan, based on letter posting date. Exclusion criteria: unclaimed letter, incomplete data, or non-drug seeking care plan. Statistics: Two-tailed Wilcoxon signed-rank test with significance of p<0.05. This study was approved by our IRB. Sixty patients were analyzed. Exclusion criteria: incomplete data (N=3), did not receive letter (N=2), and non-drug seeking care plan (N=3). This left 52 patients for analysis. Mean age was 38 years, (IQR-27-46 yrs). Male sex comprised 48% of sample population. Overall, there were 425 visits for study patients the first year and 26 during the fifth year. Mean yearly ED visits prior to care plan initiation were 8.2 (95% CI 6.7-9.7). Mean visits following implementation of care plan were: one year, 2.5 (95% CI 1.6-3.3); two years, 1.5 (95% CI 0.9-2.2); three years, 1.1 (95 % CI 0.2-2.0); four years, 0.8 (95% CI 0.4-1.3); five years, 0.5 (95% CI 0.2-0.8) (p=<0.0001). Overall, five-year reduction in visits was by 7.7 (p=<0.0001). The mean reduction in visits one year following implementation was by 5.3 (p=<0.0001). A significant reduction in visits occurred between one year and two years following implementation with a mean reduction of 0.9 (p=0.01) and between two years and three years with a mean reduction of 0.4 (p=0.02). There was no significant reduction in number of visits from three to four years with a mean reduction of 0.3 (p=0.88), or four to five years with a mean reduction of 0.3 (p=0.14). Care plans are effective as a long-term means of reducing ED visits in patients with drug-seeking behavior. ED visits were significantly decreased on an annual basis in three consecutive years following implementation of a care plan.