Practice Improvement| Volume 45, ISSUE 3, P249-253, May 2019

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Connecting Chronically Ill, Uninsured Patients Who Use the Emergency Department as a Medical Home: A Process Improvement Project

Published:October 04, 2018DOI:



      The use of the emergency department by uninsured patients with chronic health problems may adversely affect those patients’ health outcomes. Successful interventions have involved the use of patient navigators to connect the uninsured adult population with medical coverage and a medical home. The aim of this project was to use principles of patient navigation in a nurse-led process improvement intervention to connect uninsured patients to medical homes.


      ED nurses were trained to refer uninsured patients with chronic health problems to care coordinators when they were discharged from emergency departments. The care coordinator was provided by the Health Care District, a community-funded medical department. Patients were therefore connected to community-funded medical homes.


      ED nurses improved their knowledge about the overuse of the emergency department and successfully referred uninsured patients who were discharged. The referred patients successfully made contact with members of the Health Care District by phone or by attending their appointments.


      The role of patient navigators is essential in the emergency department. They assist patients to navigate through the various health care resources available in their communities, which can help to reduce ED overuse.

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      Kysha Cerisier is Advanced Registered Nurse Practitioner, Emergency Department, University of Miami School of Nursing and Health Studies, Miami FL