Discharge is not a dead end: Patient Navigators in the ER

By Meghan Checkley

Often, the ER is a point of contact for patients who do not have a primary care doctor or do not regularly seek health care.  When such people come in, I ask them “why tonight? Why now?”  As a physician, I struggle with this type of patient in multiple ways.  First, diagnosis is not always obvious without a CT or specialists’ input.   Secondly, identification of the patient’s obstacles to care often takes time to determine.  Is this patient now committed to his or her health?  Will he or she be able to go to followup appointments, make the phone calls that are necessary to get through, pay for medications, and advocate for themselves?

In comes Ms. Patsy, Patient Navigator extraordinaire.  She specializes in lowering barriers to care. While my job focuses on narrowing down diagnoses, educating the patients about themselves, and determining a care plan, her job reinforces the information and simplifies execution of that plan.   Navigating appointments and insurance issues is taxing and confusing for all of us.  In the ER, we pride ourselves as providers in getting patients in and out.  However, while expediting flow intends to help the hospital run efficiently and focus resources on the sick faster, it often distances patients who are not admitted from achieving their goals of care.   Ms. Patsy helps to reconcile this difference.  The encounter of a patient who misuses the ER for primary care changes from a frustration to an opportunity.

Since starting the Patient Navigator position three months ago, Ms. Patsy and her team have encountered more than 3,000 patients.  I ask her what she has found most surprising so far. She laughs, “Everything.  I’ve had to make connections with every type of department.  Many health care staff don’t know about each other’s services.  I feel we open doors for providers as much as we do for patients.” Ms. Patsy has visited drug rehabilitation and temporary housing programs, and next month will meet with each managed care organization to identify their social workers and stop gap personnel.  Such connections have been made before, but not systematically.

Nonetheless, she admits, working in the ER has been challenging partly because it is a place not known for followup. “When I ask some people for their phone number to help with scheduling, sometimes they don’t want to give it to me.  Trusting is hard. It’s learned.”   Further, some patients don’t take advantage of the resources provided.  While Ms. Patsy’s team is cutting down on revisits for nonemergency needs, they still must do so one person at a time. Most patients, she explains, just need to know someone cares they get to the appointment.

I’ve learned in the ER that we as providers cannot worry about everything.  Now, thanks to the Patient Navigator team, we have expanded our safety net and send patients home with their personal needs in mind.  That’s an idea worth sharing.

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Meghan Checkley and Patsy Smith work in the Emergency Department of Medstar Union Memorial in downtown Baltimore.  Patsy Smith grew up in Littlestown, Pennsylvania and Baltimore City just blocks away from the hospital.  She began as a Patient Navigator less than one year ago but has worked in the health care industry since 1998.  Meghan has an MHS in Health Policy and Management from Johns Hopkins Bloomberg School of Public Health and an MD from Northwestern University