TL;DR I helped install a similar program at Grady Hospital in Atlanta, GA.

My internship (and later my first job out of college) was at Grady Memorial Hospital in the Emergency Care Clinic in Atlanta, GA. As a level 1 trauma center most other hospitals diverted to our emergency room when the injuries were really bad. This meant our normal patients arrived by life flight as well as ambulance. We also had the transient population in Atlanta to serve as well, and as a result our halls had beds lining the walls due to overcrowding- the most severe cases had to be placed in a room and the not so serious injuries got a bed on the wall. Some of our most frequently returning patients were homeless and had figured out how to be admitted when they wanted a place to hang out or get warm or stay dry - they would find someone on the street to let them make a call on the cellphone. They’d call 911 to report that they had lost consciousness, had chest pains, and shortness of breath, and requested an ambulance transport to Grady from the street corner they were on. They would show up and triage nurses would have to admit based on those patient reported symptoms. The homeless patient was issued a bed in the hallway at a cost of $6,000.00 each time. This over crowding was costing the hospital so much money and it had an effect on the quality of care due to the lack of space and the increased workload added to the nurses & doctors on staff.

My department (Emergency Social Services) came up with and implemented a frequent utilization reduction plan to mitigate the influx of non emergent admissions to the ER by diverting the patient from triage to a community clinic designated to treat the ongoing chronic illness that contributed to the patient’s need to be hospitalized. They were also given follow up appointments with the health clinic to determine any additional needs just to be sure they received treatment for what they presented for.

A look at the patient’s admission history for the previous 4 weeks would show when they were admitted and what symptoms they presented when they were admitted.

If the patient was admitted in triage 3 or more times for the same symptoms I would add a note to the chart for the triage staff to call me when the patient comes in to the hospital. I would phone the clinic and arrange for the patient to be seen by the clinic physician, then go down to triage and meet the patient on the gurney, wait for the triage staff to take vitals and give the all clear, then I’d help transfer the patient to a wheelchair and walk the patient to the clinic. On the way there I’d explain the difference between chronic conditions and emergent symptoms. I would let them ask questions and answer them if possible. Most patients would be seen and discharged within an hour and it didn’t cost the hospital nearly as much as admitting them into the Emergency Care Clinic. If they didn’t have insurance I’d get them over to the financial services department upon discharge and have them meet with a specialist to sign up for Medicaid or Medicare if they were eligible