As Pennsylvania-based Allegheny Health Network’s Jefferson Hospital began an emergency department renovation/expansion project a few years ago, it also launched a “Front Door Initiative” that seeks to address social determinants of health among patients who visit the hospital’s emergency department.
Jefferson Hospital serves the South Hills of Pittsburgh, the lower Mon Valley, and surrounding communities that were previously at the heart of the steel industry. During a June 14 webinar hosted by the Camden, N.J.-based National Center for Complex Care and Social Needs, members of the Jefferson emergency department, including a community health worker, discussed how the program works.
Alyson Lush, program manager at the Front Door Initiative, said the project began in 2018 with funding from the Jefferson Regional Foundation, and has expanded over the past year with additional funding from the Allegheny Department of Health and the Highmark Foundation.
Their target population is patients who come to the Jefferson emergency department, who are adults and who have been discharged from the ED. Patients who meet these criteria can be referred if they have one or more social determinants of health needs, Lush said. “Through our work at the Front Door, we also support screening for social determinants of health through the use of iPads, where the patients can complete a self-assessment while they're in the emergency department. We also accept referrals from social work nurses and physicians in the emergency department.”
Once patients are connected to the Front Door, a community health worker connects them with resources in the community to help them meet their needs. When patients are referred to the Front Door after discharge, they're followed up by a community health worker who gets a better sense of their situation, and then refers them to community organizations based on their needs and the goals of the patient, Lush said. “After the short-term connection, patients are followed up for 30 days, 60 days, 90 days and optionally 120 days depending on the complexity of the patient's situation. At each of these formal touch points, the patient can be referred to additional organizations to assist them with their needs. A strong relationship between the community health worker and the patient is the most important aspect of our program. And this is really what allows patients to get connected to the resources that they need to meet their needs.”
Meredith Aumer, D.N.P., R.N., director of emergency services and EMS at Jefferson, said that in addition to building the bricks and mortar of the new department, they wanted to build more of a bridge between the hospital and the community.
“Part of being an emergency department nurse and leader is that we are very used to dealing with whatever's in front of us. That may be a sore throat or anything else that's going on with the patient,” Aumer said, “but what really is hard for the nurses and the physicians in the emergency department is knowing there's more that you can do, but not knowing what to do. You may have a conversation with the patient about getting to the pharmacy to pick up their medications, or noticing they hadn't made a follow-up visit, and not knowing if they can actually do that. Our first step previously was to talk to social work. With the Front Door, we were able to really start thinking about how we can actually connect our hospital with the community, with the community-based organizations, and be able to have more of a holistic approach on how we provide care in the emergency department. We're very proud of it. The emergency department has definitely grown. We are taking on a different way of providing care, and our patient experience scores are flourishing because of it.”
In her role as patient experience nurse in Jefferson Hospital’s emergency department, Kristin Sowers, B.S.N., R.N., follows through with patients to make sure that they have received optimal care and address any concerns or complaints. She also collaborates closely with the Front Door Initiative to refer patients who have social determinants of health needs.
“Working with the Front Door Initiative, we've been able to look past the emergency department and begin thinking about other factors that impact a patient's health beyond the ER and truly advocate for these patients in the community,” Sowers explained. “As a nurse, I've never realized barriers like the lack of transportation’s relation to post-discharge, such as how this patient gets to their doctor's appointments, or how do they even get to the pharmacy to pick up their medications. The Front Door Initiative has really been a bridge to help people and patients in our community connect with supportive resources to help them overcome these barriers. I've all also became more aware of areas of the emergency department where we can be more supportive of our patients with social determinants of health needs — for example, identify the gap for patients experiencing intimate partner violence that come to the emergency department when there's no social worker, so on site during my shift, so by working with the front door initiative, my providers and my managers discussed a process for addressing this gap for the patients of this population.”
Heather Sims, the first community health worker son the Front Door Initiative, and now the community health worker supervisor, stressed that building a relationship with a patient is the key to their success, and the first impression is important.
“If a patient doesn't feel comfortable, and heard, then that could be detrimental to their success. The main objective of our program is to offer support and assistance to bring our patients to self-sufficiency,” Sims said. “The first step to every relationship-building is just showing respect to that patient. I always take a trauma-informed, empathetic approach with the patients. When our patients are in a place where they're struggling, it is essential for them to believe in me and to trust that I'm there to help them, so I just listen to their needs, their story and their struggles and just respond with compassion and empathy. We never judge a patient for any of the situation they're in, whether that be big or small. If you're not genuine and knowledgeable, it will be really difficult to gain the trust of a patient. Active listening is very important. It's listening to understand and not just to respond. And by thoughtful listening and understanding, you can create a caring environment for the patient and their needs.”
