For the millions of Americans struggling with substance use or mental health issues, a visit to the emergency room can often be a sign of what’s lacking. Namely, access to consistent treatment or general health care outside hospital walls. Fortunately, this also means the emergency room is the very place where that can change.
A call from emergency room staff within seven days of a patient’s visit to the ER for mental health or substance use reasons has been shown to improve physical and mental function, reduce substance use, and decrease future emergency room visits or hospital admissions. The follow-up—used to connect patients with treatment options—can also lessen the chance of negative outcomes, including overdose.
“There’s evidence that if you’re connected within seven days, there’s a higher likelihood you’ll end up being connected to more long-term care,” said Omar Fattal, MD, co-deputy chief medical officer and system chief of behavioral health at NYC Health + Hospitals. “It’s about better outcomes for the patients.”
At NYC Health + Hospitals, the rate of those potentially lifesaving follow-up calls have spiked dramatically in the last two years thanks to a new protocol Dr. Fattal put in place during his project with United Hospital Fund and Greater New York Hospital Association’s Clinical Quality Fellowship Program.
Knowing how long the priority list can be for hardworking emergency room staff, Dr. Fattal’s team built entirely new tools in the hospital’s database to make the follow-up call process as intuitive as possible.
The tools include the ability to pull a daily report of those who were recently discharged, document who was reached by the follow-up calls, and measure monthly data about the outreach efforts. Dr. Fattal’s team also implemented new staff trainings and consistent meetings between facilities to share obstacles and success stories.
“We created everything for them A to Z,” Dr. Fattal said. “I’m a huge believer that people will do something if you make it easier for them and you give them the tools.”
The new process started making a significant difference for some facilities within just a few months. At NYC Health + Hospitals/North Central Bronx, for example, staff went from following up with 20 percent of substance use patients in late 2020 to 50 percent of patients by March 2021.
Then, slowly but surely, the success spread system wide, doubling the rate of follow-up calls across all 11 hospitals. In October 2022, an average of 31 percent of patients with mental illness and 26 percent of substance abuse patients received a successful follow-up call systemwide, compared to 11 and 13 percent, respectively, when Dr. Fattal’s project began at the end of 2020. Dr. Fattal noted that given the often-difficult nature of reaching these patients, well-performing hospital systems tend to hover around 30 percent.
At the facility level at NYC Health + Hospitals, some locations have reached as high as 88 percent in 2022, according to his team.
“It’s really pleasing to see the work going into action,” said Taina Jones, an associate director at the Office of Behavioral Health who helps oversee the protocol. “It’s not just spoken about...staff are actually putting in the footwork to ensure the patients are well cared for.”
On top of better patient care, the higher rate of follow-up calls also makes a financial difference for the hospitals, Dr. Fattal said. Connecting more patients to long-term care means less overload on costly emergency room or inpatient beds; plus the seven-day follow-up is a key metric tracked by insurers.
These important strides for both hospital and patient all started with Dr. Fattal’s CQFP project. He said his mentors, the leaders of the program, and the feedback he received were all part of ensuring its success.
“It definitely helped a lot,” Dr. Fattal said.
Started in 2009, the Clinical Quality Fellowship Program has trained almost 300 mid-career physicians, nurses, and physician assistants from over 50 health care facilities in the New York metropolitan area to become quality improvement and patient safety leaders in their organizations. The 15-month program graduates a new class of these change-makers on the front lines of health care each year.