Health affairs
-
Five decades ago, hospitals staffed their emergency rooms with rotating community physicians or unsupervised hospital staff. Ambulance service was frequently provided by a local funeral home. Beginning in the late 1960s and accelerating thereafter, emergency care swiftly evolved into its current form. ⋯ They also conduct timely diagnostic workups, provide access to after-hours acute care, and serve as the "safety net of the safety net" for millions of low-income and uninsured patients. But the field's success has led to a new set of challenges. To overcome them, emergency care must become more integrated, regionalized, prevention oriented, and innovative.
-
For the best health care to be provided in emergency settings, it must be based on the best available science. There are about 136 million visits to emergency departments (EDs) in the United States annually. ⋯ Recognizing that effective emergency care research spans multiple organ systems and disciplines, the NIH established the Office of Emergency Care Research in December 2011 to facilitate and coordinate funding opportunities relevant to research and research training in emergency settings. Because the NIH funds education, basic research, and large clinical trials, it plays a key role in improving emergency care.
-
Emergency care is an essential component of the care delivery system in the United States, but it received little attention during the debates about health care reform. As a result, US emergency care remains outdated and fragmented. We provide an overview of efforts to regionalize emergency care in the United States, and we both identify challenges to change and recommend next steps in five domains: people, quality and processes, technology, finances, and jurisdictional politics. We offer a commonsense approach to increasing the value of emergency care delivery by developing regionalized integrated networks of emergency care that take advantage of emerging changes in the health system and are designed to meet time-sensitive patient needs.
-
We hypothesized that using communitywide data from a health information exchange (HIE) could improve the ability to identify frequent emergency department (ED) users-those with four or more ED visits in thirty days-by allowing ED use to be measured across unaffiliated hospitals. When we analyzed HIE-wide data instead of site-specific data, we identified 20.3 percent more frequent ED users (5,756 versus 4,785) and 16.0 percent more visits by them to the ED (53,031 versus 45,771). ⋯ All three differences were significant ($$p ). An improved ability to identify frequent ED users allows better targeting of case management and other services that can improve frequent ED users' health and reduce their use of costly emergency medical services.
-
Already crowded and stressful, US emergency departments (EDs) are facing the challenge of serving an aging population that requires complex and lengthy evaluations. Creative solutions are necessary to improve the value and ensure the quality of emergency care delivered to older adults while more fully addressing their complex underlying physical, social, cognitive, and situational needs. ⋯ Among the options for "geriatricizing" emergency care are approaches that may eliminate the need for an ED visit, such as telemedicine; for initial hospitalization, such as patient observation units; and for rehospitalization, such as comprehensive discharge planning. By transforming their current safety-net role to becoming a partner in care coordination, EDs have the opportunity to become better integrated into the broader health care system, improve patient health outcomes, contribute to optimizing the health care system, and reduce overall costs of care-keys to improving emergency care for patients of all ages.