Increased use of the emergency department for nonemergent visits results in ED overcrowding, increased length of stay, and poor utilization of health care dollars. The purpose of this project was to implement an emergency department–specific case management program to reduce utilization of nonemergent visits through enhanced patient education and providing linkages to primary care providers and community resources. Implementation of a performance improvement project for emergency department–specific case management. An urban, level II trauma center with 75,000 annual visits. At-risk patients targeted for case management were defined and supported by review of literature and analysis of ED nonemergent patient demographics. A literature search revealed that patients at risk for fragmented health care included those without a primary care provider, those without health benefits, and those enrolled in Medicaid. An analysis of ED utilization for nonemergent visits in this facility correlated with literature findings. Nonemergent is defined by this institution’s reimbursement coding scale, specifically, evaluation and management levels I and II. Implementation of the registered nurse case manager role included identification of at-risk populations for fragmented health care. Networking with hospital and community resources to develop ways to meet the health care and social needs of at-risk populations was completed. Education of nursing staff, liaisons, and ED physicians regarding available resources and emergency department–specific case management principles, including enhanced patient education, was implemented. Evaluation of at-risk population visits shows a decrease in nonemergent visits by 34% (N = 6852) in 2004. A 2004 focus study showed that of 1062 patients referred to this institution’s outpatient clinic 32% (n = 339) made an appointment. Of these 339 patients, 91% (309) kept their appointments. This study reinforces the need to schedule follow-up appointments while the patient is in the emergency department. A 2004 focus study of 50 randomly selected patients who received 1:1 case manager education revealed that 60% (n = 30) had no return visits, 26% (n = 13) had 1 return visit, 8% (n = 4) had 2 return visits, and 6% (n = 3) had 3 return visits. A random study of 50 patients who qualified to receive staff case management education revealed that 58% (n = 29) had no return visits, 20% (n = 10) had 1 return visit, 4% (n = 2) had 2 return visits, 6% (n = 3) had 3 return visits, and 12% (n = 6) had 4 or more return visits. The finding of similar “no return visits” between staff and case manager suggest that case management staff education was effective. However, the increase in 2 or more visits may be related to the inability of staff to schedule follow-up appointments on the off-shift and possible inconsistency of patient case management education by staff. Limitations identified include the need for consistency by staff in case management patient education and the ability of staff to schedule follow-up appointments. Subsequent actions will include the development of an ED Case Management Core Team, thereby giving case management 24/7 coverage. Because the emergency department continues to be the “safety net” for at-risk populations, implications for expanding the emergency department–specific case management program to include individualized patient care plans is indicated.