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The ED-PACT Tool Initiative

Communicating Veterans' Care Needs After Emergency Department Visits

Cordasco, Kristina M.; Saifu, Hemen N.; Song, Hyun-Sung; Hsiao, Jonie J.; Khafaf, Mana; Doyle, Brian; Rubenstein, Lisa V.; Chrystal, Joya G.; Bharath, Purnima; Ganz, David A.

The Journal for Healthcare Quality (JHQ): April 12, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/JHQ.0000000000000195
Original Article: PDF Only

Background: Communication failures between providers threaten patient safety.

Purpose: We developed, implemented, and formatively evaluated the ED-PACT Tool, which uses the Veterans Health Administration's (VA) electronic health record to send messages from emergency department (ED) providers to primary care patient-aligned care team (PACT) registered nurses (RNs) for Veterans discharged home from the ED with urgent or specific follow-up needs.

Methods: We used Plan-Do-Study-Act quality improvement methodology.

Results: Between November 1, 2015, and November 30, 2017, the tool was used to send 4,899 messages in one local VA healthcare system (ED and associated primary care clinics). Formative evaluation revealed that providers and RNs perceive the tool as providing substantial benefit for coordinating post-ED care. Patient-aligned care team leaders reported that RN training and “buy-in” facilitated tool implementation, while insufficient staffing posed a barrier. Emergency department providers noted the advantage of having a standardized and reliable system for communicating with PACTs.

Conclusions/Implications: The ED-PACT Tool encapsulates several best practices (standardized processes, “closed-loop” communication, embedding into workflow) to facilitate communication between VA ED and follow-up care providers. Our development process illustrates key lessons in quality improvement and innovation implementation including the value of using rapid-cycle improvement methodology, with interprofessional collaboration and representatives from intended spread sites.

For more information on this article, contact Kristina M. Cordasco,

Funders: Support for this work was provided by the Department of Veterans Affairs (VA), VA Quality Enhancement Research Initiative (QUERI), Care Coordination QUERI, project # QUE 15-276 and VA Office of Primary Care, VISN 22 Veterans Assessment and Improvement Laboratory (VAIL) PACT Demonstration Lab. Dr. Doyle's time was supported by VA's Office of Academic Affiliations, VA Greater Los Angeles Quality Scholars Program (VA TQS 65-000). The views expressed within this article are solely those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the U.S. Government.

The ED-PACT Tool was previously described in presentations at the Academy Health Dissemination and Implementation Meeting, December 2016; the Health Care System Research Network Annual Meeting, March 2017; the Society of General Internal Medicine Annual Meeting, April 2017; and the VA Health Services Research and Development and QUERI national conference, August 2017.

The authors declare no conflicts of interest.

This work was performed as quality improvement and was therefore determined to be nonresearch by the Institutional Review Board of VA Greater Los Angeles Healthcare System.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article at (

© 2019 National Association for Healthcare Quality
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