Date of Award

Spring 5-28-2022

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Joseph Burkard, DNSc, CRNA, AACN Health Policy Fellow


In 2019, it was estimated there were 18 million avoidable emergency department (ED) visits, totaling $32 billion in unnecessary healthcare spending. Super-utilizers (SU), individuals that seek care in the ED 3 or more times per year, account for a disproportionately large segment of healthcare consumption and costs. These patients inefficiently access the healthcare system and often fail to get the follow-up care that could prevent them from repeat ED visits.

This evidence-based project aimed to reduce unnecessary ED visits by at least 25% annually and have no use of the ED during the intervention period, by implementing social and medical care coordination case management strategies. The intent was to provide follow-up, support, and empower patients to manage their health and keep them out of the ED.

This project was designed using the Blueprint for Complex Care and the IOWA model to promote quality care. The 5 A’s framework was utilized for post-discharge phone calls. The interventions included follow-up phone calls at designated intervals to ensure understanding of ED stay, confirm a post-discharge appointment with their primary care provider or specialist, evaluate comprehension of their plan of care and medications, and to assist them in identifying and accessing social or community resources.

Of the ten patients enrolled for the project, two of the patients returned to the ED for care during the intervention. Both patients ended up having psychiatric issues that proved to be significant barriers for comprehension of their medical diagnoses, plan of care, and ability to manage their health. The data did elucidate reductions in ED use is possible among superutilizers, without significant psychiatric issues, using the case management interventions.

Primary care providers should be aware of SU patients in their practice and arrange frequent follow-up to decrease their reliance on the ED for care.

Included in

Nursing Commons