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Copley Hospital Quality Initiative Featured at National Rural Healthcare Conference

February 7, 2019

Care Coordination in Emergency Department Highlighted

Morrisville, VT – Copley Hospital’s Care Coordination program in the Emergency Department is attracting national attention. Three of Copley’s clinical leaders involved in launching the program were invited to speak at the American Hospital Association’s 2019 Rural Health Care Leadership Conference in Arizona. The conference brings together top practitioners and thinkers to share strategies and resources for accelerating the shift to a more integrated and sustainable rural health system.

Lori Profota, Dominique Couture, and Michael Brigati stand in front of large plant after presenting at the 2019 AHA Rural Health Care Leadership Conference.
Copley Hospital clinicians Lori Profota, Chief Nursing Officer; Dominique Couture, Social Worker; and Michael Brigati, Director of Emergency Services and Clinical Life Safety, were invited to speak at the American Hospital Association’s 2019 Rural Health Care Leadership Conference. Their presentation detailed Copley’s successful Quality Initiative to reduce avoidable visits to the Emergency Department.

Lori Profota, Copley Hospital’s Chief Nursing Officer; Michael Brigati, Director of Emergency Services and Clinical Life Safety; and Dominique Couture, Social Worker, presented a workshop on February 5 at the conference, detailing the strategies Copley put into place to improve care coordination. Over the past two years, Copley has collaborated with community medical homes, the Vermont Chronic Care Initiative, local community agencies and other stakeholders to address the high cost of care. The hospital’s goal was to reduce the amount of potentially avoidable visits to the Emergency Department (ED), which in turn would reduce the cost of care in the community. Their project reduced avoidable visits to the ED by 25%, resulting in a potential cost savings to the health care system of nearly $180,000.

The hospital’s service area had a higher than average number of potentially avoidable visits to the Emergency Department (ED), while also recording below average for referrals to primary care physicians. Working in collaboration with Community Health Services of Lamoille Valley, the hospital had focused on connecting ED patients with a primary care provider, but was not seeing measurable improvement. The collaboration than placed social worker Dominique Couture in the ED with a goal to focus on a small, targeted population. Twenty-nine patients were identified as “super-utilizers” of the ED, accounting for 4% of the total ED visits in a 90-day period. It was discovered that these identified super-utilizers had a primary care provider and were insured, and while connected to social services, the care was not necessarily coordinated.  The team changed the program’s focus to better understand and address the barriers preventing the hospital’s “super-utilizers” from getting the care they needed before coming to the ED and to better coordinate access to needed services available in the community. Management of chronic conditions, along with a lack of affordable, adequate, and stable housing and transportation were identified as key issues. Couture began referring patients to the Vermont Chronic Care Initiative, Medication Assisted Treatment program, and other community resources to address social determinants of health. She followed up with the patients to ensure they followed through with referrals and helped coordinate medication and transportation, ultimately closing the loop with the patients and a long-term care manager to ensure ongoing support for needed services.

“It’s these ‘light touches’ of quick check-ins or phone calls to patients to follow up, that made a world of difference,” said Lori Profota, Chief Nursing Officer at Copley Hospital.

The initiative continues and involves care coordination with both clinical services, local health agencies, and social service agencies throughout the region. The program utilizes a framework established by the Blueprint for Health locally where care team members meet regularly via organized care team meetings in addition to the follow-up coordination from the ED social worker. Copley and Community Health Services of Lamoille Valley have expanded the program by including hospital inpatients and adding a Resource Referral Specialist in the ED.

“This has really proved that a very small amount of people or a limited amount of resources a small hospital can put into something can have really meaningful outcomes,” said Michael Brigati, Director of Emergency Services at Copley Hospital.

A copy of the presentation is available online.

About Copley Hospital
Copley Hospital is a not-for-profit Critical Access Hospital serving the greater Lamoille County region and is one of the area’s largest employers. Copley offers exceptional care from skilled specialists using state-of-the-art treatments and technology supported with the warm, personalized feel of a community hospital. Copley offers 24-hour emergency services, a family-friendly Birthing Center, and inpatient and outpatient care including Cardiology, General Surgery, Obstetrics/Gynecology (The Women’s Center), Orthopedics (Mansfield Orthopaedics), Rehabilitation Services, and Diagnostic Imaging on its campus in Morrisville.