Shared decision-making, the cornerstone of patient-centered care, often takes place in non-emergency care settings where patients have the luxury of more time to talk to their clinicians and consider all their options. But these discussions should also take place in busy, chaotic emergency departments, wrote two clinicians in a blog post for Health Affairs.
“There is tremendous potential for driving value-based care in the emergency setting through shared decision-making, wrote Edward Melnick, M.D., assistant professor of emergency medicine at the Yale School of Medicine and Erik Hess, associate professor of emergency medicine and research chair for the Department of Emergency Medicine at the Mayo Clinic. “As we continue to build incentives for value-based care into our healthcare system, we should not leave the ED out.”
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The value of decision-aids to encourage shared decision-making was made clear during a randomized control trial at six EDs across the U.S., according to the blog post. The pilot program used a decision aid, "Chest Pain Choice,” developed by Hess and his research team. Chest pain, a common reason for patient visits to the ER, often leads to unnecessary admissions. So Hess’ team wanted to see what would happen if clinicians took the time to inform patients of their options.
The results: Increased patient engagement and a reduction in unnecessary hospital admissions for cardiac testing. Hess and Melnick saw it as a “multi-billion dollar opportunity” to reduce waste in the healthcare system. The findings were so promising that the research team began working on the development of decision aids to discuss CAT scans for adults and children with minor head trauma.