Emergency Medicine Now and in the Future

by Marilyn Sherrill

Knowledge Transfer Director

Have you ever wondered how hospital emergency departments (EDs) got their name when a large majority of the people who visit them are not experiencing an emergency? Should they be called something else, or should they finally serve only those patients with emergencies? These are interesting thoughts and questions; the answers are not easily surmised.

Over the course of approximately two years, a group of emergency medicine professionals and administrators from five large Vizient member health care systems met to discuss emergency medicine now and in the future. In a white paper discussing their work they state, “Emergency medicine leaders and their health systems are at crossroads. They can continue the traditional approaches to patients who come to the hospital wanting and or needing immediate care and make incremental improvements, or they can look to innovative ways to partner with their communities to optimize care delivery and improve outcomes for these patients.”

Three themes emerged as the group considered concepts for the future of emergency medicine: Emergency departments as a site for advanced, real-time diagnostics; as a front door for access to the entire health system and as a place to integrate the social determinants of health into clinical practice.

In support of building a business case for the implementation of a new delivery framework, the discussion evolved around the key aspects of access, outcomes, cost and consumerism.

What the group determined was that viewing the ED as the front door into health care organization as systems was the ideal state, and that the ED can be a driver of growth for all other service lines. In order to successfully implement this new approach, health systems will need to develop strategies to support desired growth and positive patient expectations and experience from ED interactions. Here are the foundational concepts that must be considered when developing a business case for change.

Medical practice for emergency medicine

This concept tackles meeting the patient need for quick, responsive evaluation in a cost-effective way. Strategies include staffing ED with specialty providers to address non-urgent and non-emergent needs, including those versed in behavioral health, internal medicine, pediatrics and geriatrics with a mechanism for navigating patients from the ED to the appropriate providers.
Hospital operation/national health care environment.

Hospital operation/national health care environment

Strategies for this concept include using a system perspective to drive patients to appropriate sites of care to manage system capacity and meet the goal that all patients receive equitable care. Strategies should also factor in payer drivers and potential shifts in national health care policy.

Population health/social determinants. 

This foundational concept focuses on building community partnerships around the issues that impact patients and lead them to seek nonemergent care at the ED with a goal to encourage patients to seek appropriate/alternative sites of care outside of the ED. Strategies may include partnering with emergency medical services, police and fire departments, skilled nursing facilities, clinics, home health, social service agencies, etc.

The work to identify new approaches to ED services will continue and must also factor in learnings from COVID-19, which certainly added a new dimension to the challenges of emergency medicine. The future of emergency medicine, and the proposed changes are innovative, evolutionary, and exciting.  

To learn more about this work, access the white paper and listen to the 3-part “EM of the Future” podcast series along with a COVID-19 bonus edition.