Emergency Repairs

Jim Molpus, for HealthLeaders magazine , January 15, 2008
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At one point in my career, I was a television critic hobnobbing in Hollywood with network actors, executives and producers. I remember back in 1994 I was at a reception for NBC's new fall shows at the Universal Hilton in Los Angeles talking to Anthony Edwards, whom at that time I only knew as Gilbert in Revenge of the Nerds. He was promoting his new show, another medical drama titled simply ER.

At the time it was up against a show on CBS with a higher acting pedigree--Chicago Hope, with Adam Arkin, Mandy Patinkin and Hector Elizondo. Being the sage critic that I was, I chose Chicago Hope as the runaway hit of 1994. ER went on to rank as the most popular show on television in three of its first five years and now in its 14th season stands as the longest-running medical drama of all time.

Television writers and producers are obsessed with hospitals because they are a perfect vehicle for life-and-death drama, mixed with humor. (They can also squeeze in a lot of nice-looking young doctors and nurses, which does not hurt ratings.) What makes ER such a reliable old show is that writers can think of virtually any person, any pretext, and choose from a mix-and-match set of life-threatening injuries or illnesses to bring through the front door. Now, although not many real hospital emergency departments have seen their despicable chief of surgery squished in the ambulance bay by a crashing helicopter like Dr. Romano was, every emergency department has stories. Every real ER is simply a wild place, full of surprises.

So it is understandable that emergency departments create their own culture. But it is that same culture that often becomes a barrier when a hospital attempts to bring the ED on line with the rest of the hospital on quality, customer service or clinical IT. For this month's cover story, our leadership editor, Molly Rowe, found hospitals that have managed to smooth the rough edges that exist between the hospital and the ED, whether that means prioritizing ED orders from the lab or gently forcing ED leaders into hospitalwide leadership committees.

The doors of the ED open to tragedies that are immediate and ever changing. At the same time, the ED is not immune to rising demands from consumers for improved consistency in quality and service from every part of the hospital. So although the ED will never be the boring part of the hospital, hopefully it will be the site of a bit less drama in the future.

Jim Molpus

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