Navigating a New Option for Patients

Mark Spiro , MD, FACEP

Former president

Published June 27, 2012

The patient navigator shows how a small scale change and modest expenditure could quickly yield improvements in ED resource utilization while at the same time providing much needed support to patients. This could be a “win win” for patients, hospitals and ED staff.

Patient navigator programs, an example of which is currently in use at Sutter Health emergency departments in Sacramento, attempt to broaden the help given to ED patients. The program at Sutter General and Sutter Memorial Hospitals is still very new, with the pilot phase just completed in the fall of 2011. It places patient navigators, usually trained social workers, in the ED. Their job is to assist patients who do not have access to follow-up care.

It’s a simple process: when ED staff members identify patients who do not have sources of post-acute care, they call in the navigators. These navigators then work to find available and appropriate social services for patients who do not have insurance, aren’t enrolled with a primary care doctor, have mental health problems, or are homeless. In 2011, the navigators at Sutter made 881 referrals to provide insurance, housing and medical services.

Considering that all patients have the right to come to the ED for help, it makes a lot of sense to provide them the help they need, even when they need something that ends up being an issue not related to emergency medicine. Doing this not only helps the patients, but also saves money for the ED. As discussed in the aforementioned Sacramento Bee article, Sutter spends about $150,000 per year to outsource the cost of the program to a local healthcare nonprofit. This very small investment could bring far reaching benefits across the entire ED.

The navigator program frees up the time of physicians in the ED and opens up beds. Even if a small percentage of the 881 referrals get the help they need and stop using the ED for non-emergency purposes, it would be a large benefit for these patients and could ripple across the entire ED.

Navigators in the ED help patients meet their medical, social and economic needs so that they may not return for something that is not and does not have the potential to be urgent. This, in turn, also helps the ED by inexpensively addressing at its core the problem that certain patients rely on the ED for much more than emergency medicine.

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