Objectives: Identify the role of the emergency department CNL, focus of practice in a community hospital, and key care coordination strategies used.
Background: The CNL role quickly spread to all inpatient units at an organization since implementation in 2012 and is now fully operational in the emergency department. The CNL focuses include care coordination, organizational initiatives and education, and quality measures. The ED is a unique ambulatory setting that is a gateway for the community to either access the hospital or connect with outpatient resources. Making connections for complex patients and vulnerable populations is at the heart of the ED CNL role.
Methods: The ED CNLs optimize interdisciplinary collaboration by functioning as a connector for care across many clinical settings. One key intervention that the ED CNL leads is that of the creation of complex care plans for the highest utilizer patients in collaboration with physicians, social workers, and other pertinent departments. Connections with primary care ambulatory sites are achieved, as well as community partnerships, the tracking of patient progress, and development of personal connections with patients.
Practices: ED CNLs aim to reduce hospital readmissions and ED utilization through a multi-faceted transitions management program. Elements of the CNL role center on the RN as care coordinator, which is vital in today's healthcare environment.
Outcomes: The success of the CNL has been due in large part to positive change in readmissions 12% in 2014 to currently 7.3%), length of stay, core measures, and other patient outcomes. The CNLs have developed 20 complex care plans for the highest ED utilizers, which 0/20 have readmitted in under 30 days. Additionally, the ED CNLs have begun to more intentionally create a pipeline for patients to primary care providers.
Recommendations: ED CNLs continue to broaden their scope of impact on chronic and vulnerable populations. Plans are underway to engage with ambulatory clinic nurses and other health systems to sustain the important connections being made through these complex care plans.