The hospital emergency department—the busy, noisy, usually chaotic place that it is—has always been a vital pathway into the hospital, the source for 50% to 60% of admissions.
But now, with new healthcare reform laws and smarter ways of thinking about optimal medicine, the ED is being asked to pave a much different path, one that may lead out of the hospital as much as it leads in; a U-turn lane of sorts for patients who can be more effectively—and less expensively—cared for at home or in another setting.
“Our role may very well be changed,” acknowledges Rebecca Parker, MD, Midwest regional medical director for Dallas-based EmCare and a member of the board of directors with the American College of Emergency Physicians.
“There’s a push for a new focus, to keep patients out of the hospital, and we’re going to be key components of that. As they leave our doors, we’ll need to help them get assistance, and right now, we don’t do a lot of that,” she says.
In many ways, the ED world will soon be turned upside down. Its doctors and staff may increasingly be called upon to make sure patients aren’t admitted in the first place, lest the hospital be financially penalized by federal or private payers. ED staff may include home care planners and case managers who spend half their days making postrelease phone calls or even visiting the homes of patients most likely to return, perhaps in much worse shape.
A palliative care coach may be a part-time if not a full-time member of the emergency team to make sure dying patients don’t spend their last days in an inpatient bed getting care that is ultimately futile, care that is not what the patients would have wanted.
Flow charts and architecture are being remodeled for the ED with more attention—much more attention—being paid to the patient experience, even to the idea of giving patients iPads to use while they wait. Payment strategies to guarantee legally required availability of specialists on call are being redesigned with an increasing emphasis on some level of guaranteed payment per patient.