The gold card: A novel dispatch process to guarantee timely specialist followup.

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Study Objectives: Within the current climate of ED crowding, hospitals arecontinually experimenting with new ways to streamline patient throughput. Oneoption to prevent crowding is early discharge of patients whose specialistevaluation could safely be provided in theoutpatient setting. However, reluctanceon the part of the patient, the specialist, and emergency physician to dischargepatients without confirmed follow-up leads to increased observation and admissionof certain patient groups. At our institution, we noted that a significant number ofpatients were waiting on both the inpatientfloor and the ED observation unit forspecialty consultations, which could have been done in the outpatient setting werefollow-up guaranteed. Our objective was to determine if initiating a novel‘goldcard’program, where patients were guaranteed follow-up with a group ofparticipating specialists within two business days would be feasible in thecommunity hospital setting.

Methods: From August 2016 to March 2017, we conducted a prospectiveobservational study of all discharged ED patients who participated in the‘gold card’program. This study was performed through a community hospital ED with 98,324annual visits. All adult (age>18) patients who were deemed by the treating emergencyphysician as candidates for a‘gold card’were screened by a care coordinator to confirminsurance eligibility and provided a‘gold card.’This‘gold card’guaranteed anappointment with the selected specialist within two business days. All patients whoparticipated in the program were contacted to evaluate the feasibility of the process.Our primary outcome measure was the number of‘gold card’recipients whocompleted an appointment within two business days of discharge. Our secondaryoutcomes included: 1) patient satisfaction with the process, 2) reasons for notcompleting a gold card appointment, and 3) an analysis of utilized specialists. The datawas analyzed using descriptive statistics.

Results: From August 2016 through March 2017, there were 65,912 visits toour ED. 42,886 (65%) of these patients were discharged home, 17,202 (26%)were admitted, and 5,824 (9%) were sent to ED observation. Of the total EDdischarges during this period, 1,508 patients (3.5%) received a gold card. Withinthat cohort, 119 patients (7.8%) chose not to go to the appointment: 86 (72%)canceled and 33 (28%) no showed. Of the 1,389 remaining gold card patients,1,264 (91%) were seen within two business days, 109 (8%) were seen within morethan two business days, 15 (1.07%) were unable to schedule an appointment, and1patient(<1%) was readmitted. A follow-up phone survey was completed on1,009 patients (74%), demonstrating an average monthly patient satisfaction rateof 98.7% with the program, alongside increasing‘gold card’usage(SeeFigure1).There was a broad range of specialty participation with gastroenterology (22.7%),cardiology (13.4%), and neurology (13.0%) encompassing almost half of allreferrals

Conclusions: The‘gold card’program represents a feasible option to provideurgent specialty appointments for select patients who otherwise would remain in thehospital to see their consultants.