title: Implementing a medical screening and referral program for rural emergency departments.
abstract: BACKGROUND
  Emergency Department (ED) overcrowding due to nonemergent use is an ongoing concern. In 2011, a regional health system that primarily serves rural communities in Texas instituted a new program to medically screen and refer nonemergent patients to nearby affiliated rural health clinics (RHCs).
  
  
  OBJECTIVE
  This formative evaluation describes the program goals, process, and early implementation experiences at 2 sites that adopted the program before wider implementation within the rural health system.
  
  
  METHODS
  Primary data collection including document review, internal stakeholder interviews, and direct observation of program processes were used for this formative evaluation of program implementation in light of program goals and objectives. Fourteen key informants were asked questions related to the program concept, structure, and implementation.
  
  
  RESULTS
  The program, as implemented, aligned with initial program goals, but it was dependent on ED screening staff and RHC availability. Some adjustments to the program were needed, including RHC hours, consistency among staff in making referrals, patient education, and improving patient uptake on the referral. Stakeholders reported lessons learned related to training, staff buy-in, Emergency Medical Treatment and Labor Act (EMTALA), and intraorganizational cooperation.
  
  
  CONCLUSIONS
  The system was able to leverage excess capacity of affiliated RHCs to accommodate low-acuity patients referred from the ED and may lead to improvements in Triple Aim goals of increased patient satisfaction, better population health and outcomes, and lower per capita costs. Lessons learned from this program may inform similar processes aimed to reduce nonemergency ED utilization by other rural health systems.
authors.affiliation: Department of Health Policy & Management, Center for Health Organization Transformation, Texas A&M Health Science Center, School of Public Health, College Station, Texas.
authors.forename: Terri L
authors.initials: TL
authors.lastname: Menser
authors.forename: Tiffany A
authors.initials: TA
authors.lastname: Radcliff
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Schuller
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D010353:Patient Education as Topic; D012017:Referral and Consultation / Q000458:organization & administration*; D013781:Texas; D014218:Triage / Q000458:organization & administration*
keywords: emergency medicine; medical screening; organizational change; quality improvement; rural health clinic