Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
By the year 2020, when many in my generation of physicians are no longer practicing, healthcare will look very different due to the Affordable Care Act (ACA). The road ahead will require a lot of collaboration between physicians, hospitals, health plans, patients, and more. Physician leadership is now needed and wanted at all levels. And I think it is very important that younger physician leaders—the physicians who will actually be practicing in the future—join in the planning for and leadership of that future.
I am never surprised at just how talented and well-rounded physicians are. And I am not just talking about physicians that I work with, but all who successfully navigated med school. So the question is not whether there are enough good young leaders, but how they can most effectively be engaged and then empowered to lead?
Back in the old days medicine was practiced through home visits. In the early 20th century, as healthcare became institutionalized and medical insurance replaced ‘pay-as-you-go’, home visits became a thing of the past. Today there are a multitude of factors that are giving the practice of home visits a second look, and I think this is a positive development.
The patient navigator shows how a small scale change and modest expenditure could quickly yield improvements in ED resource utilization while at the same time providing much needed support to patients. This could be a “win win” for patients, hospitals and ED staff.
Patient navigator programs, an example of which is currently in use at Sutter Health emergency departments in Sacramento, attempt to broaden the help given to ED patients. The program at Sutter General and Sutter Memorial Hospitals is still very new, with the pilot phase just completed in the fall of 2011. It places patient navigators, usually trained social workers, in the ED. Their job is to assist patients who do not have access to follow-up care.
I read the recent CDC report on “Emergency Room Use Among Adults Aged 18-64: Early Release of Estimates From the National Health Interview Survey, January-June 2011”[PDF] and felt compelled to respond. As an emergency physician helping to lead a physician group which sees four million emergency patients per year, I had both an intellectual and emotional response to this article. My comments are about this specific article as well as the general issue – the widely held belief that there are too many ED visits. I hope my ED based perspectives will be viewed as helpful and not defensive.
I have doubts about the conclusions based on the data because of the retrospective design of the study and the small number of surveys used. Most of these studies were done retrospectively based on discharge diagnosis. One conclusion from the CDC study was that only 54.5% of visits required a hospital for their care, suggesting that only these patients had true ‘emergencies.’ The lay public are often very unaware as to what is a serious problem needing emergent or very urgent care versus a not so serious problem—especially prospectively.
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