Patient Assistance for Virtual Emergency Room Follow Up (PAVER)

Purpose: Patients returning to the emergency room within 30 days of a previous visit pose a transitions of care issue for hospitals; with a reported 19.9% of initial ER visits resulting in a revisit. The cost of a revisit has been reported to be 118% the cost of the initial visit and 26% of ED revisits result in a hospital admission. Patients who utilize the ER for primary care services due to being under resourced have been identified by AHRQ as having multiple risk factors that place them at risk for ER revisit. Memorial Hermann Southwest serves a large indigent patient population and has recently added a part time pharmacist position to assist with preventing ER revisits. Previous literature has demonstrated that pharmacist ER discharge phone calls are able to reduce 30-day ER patient revisits; however, a more efficient method to prioritize patients to call is desired. The use of an electronic survey application known as Vivify has been identified as a potential way to help the pharmacist prioritize which patients they contact. The primary purpose of this study will be to assess the overall impact on 30-day ER revisits seen in an ER equipped with a pharmacist utilizing an electronic health survey application. Methods: A retrospective quasi experimental study was performed to evaluate the 30-day revisit rate seen between patients who downloaded the application and those who did not. Patients were excluded if they were younger than 18 years of age, presented to the ED for emergent dialysis or psychosis, were admitted during their primary ED visit, or enrolled in the hospital’s COPD or CHF Vivify program. The primary outcome was to assess the 30-day revisit rate seen between the group that downloaded the Vivify survey application and all enrolled patients who did not download the application. Secondary outcomes included an assessment of the rate of survey downloads and responses and an analysis of the clinical interventions made by the pharmacist. Results: This study enrolled 2053 patients across four months. 93 patients downloaded the application, 79 completed the survey, and 54 patients were able to be contacted by a pharmacist. The revisit rate seen by the application download group was 8.06% while the revisit rate for the non-download group was 12.7%. A chi-squared analysis was performed and showed a non-statistically significant difference between these two groups (χ2=1.12, p=0.29). No statistical differences were found between the enrolled group and downloaded group for age, ethnicity, and payer; but a statistical difference in the gender ratio between the two groups was noted. The clinical pharmacist was able to perform 1.33 interventions for each at risk patient they contacted with 18.75% of interventions being clinical in nature, 43.75% involved cost interventions, and 37.5% of interventions were used to help the patient arrange a follow up visit or find a primary care provider (PCP). Conclusion: The utilization of a pharmacist equipped with an electronic survey application was unable to show a statistically significant reduction in 30-day ER revisits. While groups intervened on by the pharmacist showed a beneficial trend in reducing 30-day ED revisits, the sample size that was able to be captured with the limitations noted was not large enough to detect a difference seen in ER revisit rates.