Two projects: Easing the pressure on ERs, and the lack of post-acute care for psychiatric patients

Published on
November 1, 2018

I’ll be tackling two projects as part of my 2018 Data Fellowship.

The first: San Diego hospitals seeking to steer non-emergency patients away from emergency rooms.

My idea arose from analyzing ER data of county healthy systems. This analysis illuminated ER trends that aren’t ready for prime time yet, but will be included in my coverage.

I have a sense of how hospitals are discouraging the use of the ER as a doctor’s office. In recent months I’ve covered hospitals’ expansion of outpatient sites and same-day clinics. Among the reasons for doing so was to ease the pressure on ERs.

But it seems that’s only one part of a strategy to curtail unnecessary ER trips. I’ll be calling up hospital systems and outside observers to learn more.

Much appears at stake, both financially and in terms of patient care.

In general, it’s significantly less expensive for hospital systems to treat patients in non-emergency settings like walk-in clinics, according to Doug Halley, a partner at Deloitte & Touche.

Key phrase here is “in general.” I want hard numbers.

The goal is to drill down to San Diego hospitals’ emergency room costs over the years. I’ll be seeking this data from Centers for Medicare & Medicaid Services’ cost reports, which I’m told are tricky to navigate, so guidance from Halley and other financial professionals will be key.

I’d welcome any other suggestions on this front.

As a reference point, unnecessary ER visits cost Americans more than $38 billion a year, according to the nonprofit and non-partisan New England Health Institute. This impacts taxes and premiums.

Also to be explored: How are aforementioned trends affecting county ER wait times? Are ERs typically suited to handle non-emergency cases?  

That’s project one.

Background for my second project: Tri-City Medical Center in North County San Diego recently closed its inpatient mental health and crisis stabilization units, sparking a larger conversation about a shortage of mental health beds in San Diego County.

A functioning psychiatric emergency system hinges on enough beds and facilities for psychiatric patients, county and hospital officials have said. This matter too has bearing on a regional homelessness crisis.

Against this backdrop, my project will focus on another important piece. For psychiatric patients deemed as no longer needing acute care, what’s next is often a skilled nursing facility or other step-down service.

Based on county data obtained, I plan to cover apparent challenges in accessing step-down services — and what that means for patients, hospitals and skilled nursing facilities. 

Since we’re a business journal, I’m interested in the financial angle, but woven in too will be patient health.   

With the help of my editors, I feel as though I’ve made solid progress in these projects. But I look forward to learning new data skills and swapping ideas with reporters to advance these stories.