Discharge Alternative Non-Urgent Care Education (D.A.N.C.E.) Protocol: Addressing Emergency Department Misuse
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Background: The misuse of the Emergency Department (ED) creates a substantial problem for the health care system, generating gaps in continuity of care, leaving little room for preventative care, and forcing a financial strain on the system. An increasing number of patients are using hospital EDs for non-urgent care despite the availability of alternative care sites such as retail clinics (RCs) and urgent care centers (UCCs). Purpose: The project’s aim was to educate patients who utilize ED services as a source of care for non-urgent complaints with the use of the D.A.N.C.E. protocol. Enhancing the public’s knowledge of the ED’s purpose and the services available at alternative care sites could provide a potential solution to ED misuse and subsequent overcrowding. Theoretical Framework: The Andersen Framework of Health Utilization Services was used to guide this project, as it uses a systems perspective to integrate individual, environmental, and provider-related variables associated with decisions to seek care. Methods: The D.A.N.C.E. protocol was implemented in a pilot project with the use of an educational protocol delineating functions of alternative care sites and EDs. Face validity was established by a staff consensus panel, and the protocol was then distributed to lower acuity patients discharged from the ED. At the completion of the patient’s review of the protocol, a survey card was provided evaluating which care site would be selected for the same or similar non-urgent complaint in the future and whether the protocol influenced this decision. Results: A sample size of 22 completed surveys were returned with 55% (12) selecting the ED, 36% (8) selecting UCC/RC, and 9% (2) selecting their PCP for future care site. The majority of the surveys showed that 91% (20) of the participants found the protocol influential and 9% (2) selected the protocol had no influence on their future care site decision. Conclusion: Despite more than half of the patients selecting the ED as their next potential source of non-urgent care, a post discharge intervention did seem to influence care site selection. Several factors presented during this project requiring further examination to better address these patients’ health care seeking behaviors.