Too often in this country, emergency room visits are treated like standalone events—“right swipes” of medical care characterized by brief encounters that fix the most emergent issues before patients are sent on their way.
Recently, I read an article comparing emergency department utilization to one-night stands, and it made me cringe. There’s a growing perception that ED encounters are superficial, shallow, skin-deep, and often without a second thought to the patient’s long-term needs. This couldn’t be further from reality and is a dangerous precedent for physicians to reinforce.
If everyone could only walk a shift in the shoes of America’s emergency providers, they might understand our frustration with this perception. The ED setting oversees more than 130 million visits annually. Sure, some patients seek a no-strings-attached encounter with our health system, but most physicians see themselves as stakeholders in long-term health. Many patients don’t have the resources or support needed to navigate the complexities of healthcare. Outside of the ED setting, many of these patients are pretty much on their own.
No argument that it’s a challenge. We often have less time to make decisions and little to no access to personal details or insight into a patient’s past care. So how do we turn patients' emergency room encounters into meaningful, long-term relationships with the healthcare system?
The answer, as I see it, lies with improving transparency, communications, and collaboration. And instead of pointing fingers, this would require involvement from all physicians across the continuum.
Better communication naturally ties into better collaboration. Every visit, diagnosis, allergy, prescription and more has the potential to radically change how a physician interacts with a patient. So instead of squabbling, we need to make sure we have the right information about a patient, so the ED visit—or any visit—leads to the best possible outcome.
Patient notes must be comprehensive and easily shared across disparate technology systems. We can and should share evidence-based medicine with our peers, or best practices for dealing with specific patients. We need to use technology that supports efficient workflows rather than simply dispatching meaningless alerts in sequence.
Easier said than done. The good news is that we’re starting to address these challenges. One example is a new healthcare delivery model unveiled in 2017 by Michigan emergency physicians to integrate primary care into a rural hospital’s ED operations.
Another example comes to mind: In 2012, I had the opportunity to participate in the ER is for Emergencies program, a collaboration between emergency departments and medical associations in Washington state that uses the network and platform of Collective Medical as its technical backbone.
Through the program, hospitals shared access to a technology health information network that pulls together patient data from multiple healthcare systems. It then filters essential intelligence into one-page reports that are pushed to physicians and clinicians at the point of care. They have the most critical information at their fingertips when they need it.
This single technology system enabled us to easily flag high-risk patients (e.g., those with a history of substance use disorder, or disease flare-ups). In turn, this has helped us facilitate the most timely and appropriate interventions. This program reduced ED visits by nearly 11% within 12 months, improved outcomes, and saved the state’s Medicaid program $34 million.
Many patients have needs far beyond the emergency department. Through technology that offers visibility into the continuum of care, we can do our best to ensure patients are getting what they need outside of the ED. There are also support tools, policies and programs that are linked with long-term outcomes, not quick-hit victories (like patient-satisfaction surveys, which aren’t comprehensive indicators of quality care).
I have hope for the future of healthcare in the United States. I believe we can improve outcomes and decrease the cost of healthcare while increasing quality through communication and collaboration. This includes trimming the excess and being the best utilizer of our resources.
Ultimately, our relationship with patients in the emergency department is far from a one-night stand. There is a need from one side (patient) and a desire to find a solution (among physicians and their teams) every hour of every day. This isn’t two individuals looking to fulfill the other’s needs in a shallow, impersonal way. It is much more than that.