ER is for Emergencies

The ER is for Emergencies campaign encourages adoption of the "Seven Best Practices" program by emergency and primary care physicians, hospitals and other health professionals. The goal of the Seven Best Practices program is to redirect care to the most appropriate setting, reduce low acuity and reduce preventable Medicaid emergency room visits. The plan focuses on high users and attempts to address the root of the problem—chronic medical conditions, substance abuse issues, and lack of primary care access.

Seven Best Practices

1. Electronic health information - Adoption of an electronic emergency department information system on a statewide basis to create and act on a common, integrated plan of care related to patients with high needs (five or more visits in a rolling calendar year) by all emergency rooms, payers, mental health clinics, and is sent to primary care providers.
2. Patient education - Dissemination of patient education materials by hospitals and payers to help patients understand and utilize the appropriate resources for care. This would include plans sharing with patients and providers where they can get off-hours coverage for primary or urgent care, including through nurse call lines, and having this information easily available on their websites.
3. Identify frequent users of the emergency department and EMS - Frequent emergency department or EMS users are identified as those patients seen or transported to the ER five times within the past 12 months. Hospitals should identify those frequent users upon arrival to the emergency department and develop and coordinate case management, including utilization of care plans. Plans, EMS, and mental health clinics will work with patients with five or more visits to identify and overcome core issue which is documented in statewide information system.
4. Develop patient care plans for frequent ER users - A process to assist frequent ER users with their care plans, such as contacting the primary care provider within 72-96 hours and/or notifying the provider of an emergency department visit if no follow-up is required. Payers will provide the information system with the names of the primary care or group for Medicaid patients and provider fax number.
5. Narcotic guidelines - Reduce drug-seeking and drug-dispensing to frequent ER users through implementation of guidelines that incorporate the WA-ACEP opioid prescribing guidelines.
6. Prescription monitoring - Emergency department physician enrollment in the state's Prescription Monitoring Program. The PMP is an electronic online database used to collect data on patients who are prescribed controlled substances, ensuring coordination of prescription drug prescribing practices.
7. Use of feedback information - Designation of a hospital emergency department physician and hospital staff responsible for reviewing the reports of frequent ER users to ensure interventions are working, including a process of reporting to executive leadership.

Patient brochures, educational videos, and more.

Role of primary care physicians

This isn't a problem only to be solved by hospitals and emergency medicine physicians. Primary care and community physicians can help achieve success by:

• Educating patients on the appropriate places to go for care;
• Helping with the lack of access issue by making room in their schedules to accommodate Medicaid patients who are re-directed to the outpatient setting for care;
• Participating in Prescription Monitoring Program (PMP) that allows physicians and pharmacies to track what controlled substances patients are having filled.

A patient brochure, "Doctor's Office, Urgent Care Clinic, or the Emergency Room?," is available for use with your patients to help redirect care to the most appropriate setting. Order a supply for your waiting room at the top of this page. 

View Spanish language version only, no printed version.
View Vietnamese language version only, no printed version.

The WSMA encourages all physicians to enroll in the Prescription Monitoring Program (PMP), an electronic online database with data on patients prescribed controlled substances.

Educational videos

Reducing Preventable ER Visits
A presentation by Nathan Schlicher, MD, JD, emergency room physician, legislative affairs chairman, WA-ACEP, WSMA member. Dr. Schlicher talks about implementing the alternative plan to the state's "zero tolerance" plan to deny payment for Medicaid emergency room visits. He discusses in detail the seven best practices that must be implemented by hospitals and physicians across the state as part of the alternative plan.

Alternative Plan to Reduce Preventable ER Visits
Dr. Nathan Schlicher gives a brief overview of the above presentation about implementing the alternative plan to the state's "zero tolerance" plan to deny payment for Medicaid emergency room visits.

Role of Primary Care and Community Physicians
Primary care and community physicians as well as specialty physicians play an critical role in a successful effort to reduce preventable emergency room use. Lack of access to care is a major contributing factor. Dr. Nathan Schlicher talks about how physicians can help the effort.

Narcotics Guidelines and PMP
Dr. Nathan Schlicher gives an overview of the Narcotics Guidelines that standardizes narcotic prescribing in the emergency room. In addition, Dr. Schlicher discusses the Prescription Monitoring Program (PMP) that allows physicians and pharmacies to track what controlled substances patients are having filled. All physicians are encouraged to participate in the PMP.

When illness, accidents, and injuries happen, where should you go for care—doctor's office, urgent care clinic, or emergency room? Where you go for care matters.

For most medical problems you should go to your regular health care provider first. You get the best care because they know you and your medical history. But if you are unsure, here are some tips to help you decide. Remember, no matter where you go for care, be sure to bring a list of the current medications you are taking.

Doctor's office or clinic

The best place to get care is a doctor's office or clinic for common illnesses, minor injuries, and routine health exams. Your doctor can also help you manage your health over time. You should make an appointment with your doctor's office for:

• Common illnesses such as colds, flu, earaches, sore throats, migraines, fever or rashes
• Minor injuries such as sprains, back pain, minor cuts and burns, minor broken bones, or minor eye injuries
• Regular physicals, prescription refills, vaccinations, and screenings
• A health problem where you need advice

Usually open during regular business hours. May have some extended hours and weekend appointments.

Urgent care clinics

When your doctor is not available, urgent care clinics provide attention for non-life threatening medical problems or problems that could become worse if you wait. Urgent care clinics provide walk-in appointments and are often open seven days a week with extended hours. When your regular doctor or health care provider is not available, you should go to an urgent care clinic for:

• Common illnesses such as colds, the flu, ear aches, sore throats, migraines, fever, rashes
• Minor injuries such as sprains, back pain, minor cuts and burns, minor broken bones, or minor eye injuries

Usually open extended hours into the evening and on weekends. Some urgent care clinics are open 24 hours a day, seven days a week.

Hospital emergency rooms

You should use a hospital emergency room for very serious or life threatening problems. Hospital emergency rooms are not the place to go for common illnesses or minor injuries.If you are experiencing any of the following symptoms, don't wait! Call 911 or get to your nearest hospital emergency room.

• Chest pain
• Severe abdominal pain
• Coughing or vomiting blood
• Severe burns
• Deep cuts or bleeding that won't stop
• Sudden blurred vision
• Difficulty breathing or shortness of breath
• Sudden dizziness, weakness, or loss of coordination or balance
• Numbness in the face, arm, or leg
• Sudden, severe headache (not a migraine)
• Seizures
• High fevers
• Any other condition you believe is life threatening

Open 24 hours a day, 7 days a week, 365 days a year.

After-hours help line numbers

During regular office hours, call your doctor's office. Many insurance companies and hospitals have a 24/7 nurse help line to help you decide where to go for care after hours. For those with the following:

Aetna
(800) 556-1555

Amerigroup
(866) 864-2544

Community Health Plans of Washington (Basic Health, Healthy Options/CHIP, Medical Care Services, Washington Health Program, Medicare Advantage)
(866) 418-1002 (nurse advice line)
(866) 418-1006 (TTY for speech and hearing impaired)

Coordinated Care
(877) 644-4613

Group Health Cooperative
(800) 297-6877

Molina (Basic Health, Healthy Options, Medicaid)
(888) 275-8750 (English)
(866) 648-3537 (Spanish)

Premera Blue Cross
(877) 728-9020

UnitedHealthcare Community Plan
(877) 543-3409

Those with other insurance carriers should check their insurance cards for information.