The emergency department (ED) of the future will likely be, as Wesley Curry, MD, points out, a very busy place with an incredibly high volume of patients walking through the door. We can expect the private ED of tomorrow to resemble the county ED of today. If so, I look forward to being an emergency physician in the future, and I think you will too.
That is because I have had the pleasure of working at one of the busiest emergency departments in California. Santa Clara Valley Medical Center [SCVMC] is a level one trauma center treating about 140,000 patients per year. Because we are a public hospital, resources are scarce, volume is very high, staffing is low, and patients often come to us without prior access to primary care. As a result, by the time they arrive in the ED, they are very sick. Despite what others might consider “overwhelming” or a “harsh environment,” I am honored to be a part of a strong group of physicians and healthcare workers providing care to so many medically underserved patients. This is, in fact, the environment that I was looking for when I started my career.
Why do I want to work this way? Because I value the mission and the passion that I share with my coworkers: that caring for the medically underserved is rewarding in and of itself. Our patients are incredibly grateful for our work, as well. You can see this spirit in a video that was made at SCVMC recently. The teamwork and camaraderie in our ED is heartwarming and certainly makes the job more easy and enjoyable. Despite recent changes our hospital system has gone through, our group has shown resilience and dedication to our core mission. We not only want to be there for our patients, but we strive to provide exceptionally high quality care.
Much has been written recently about the need to move primary care out of the ED. A good portion of our patient population cannot afford primary care and so we are honored to provide it for them. Our services run the gamut from dealing with traditional emergencies, traumatic or otherwise, to treating high blood pressure and refilling their maintenance medications. In doing this our group has been innovative in maximizing our resources. We have successfully utilized Rapid Medical Evaluation® and have established exceptional door-to-provider times. We often treat and admit patients from the ED waiting room and completely bypass the ED!
We have also been creative in our use of urgent care centers (UCCs). The hospital system has worked with the ED to provide next day visits to our UCC. These special appointments are targeted at avoiding admissions that can be prevented with very close follow up and after care. For example, it is reassuring to know that a patient that I see in the ED today who has no insurance or primary care physician, and who does not necessarily need to be admitted but does need closer follow up, can be safely discharged with an appointment during one of the dedicated slots tomorrow at the county affiliated UCC for a recheck and continued treatment (such as re-dosing of parenteral antibiotics, follow up testing, or cancer evaluations). Financially, this saves the county a tremendous amount of resources and money. For patient safety, we minimize their exposure to hospital-acquired infections and enable patients to rehabilitate at the comfort of their home. This in turn leads to decreasing boarding time in the ED, better patient satisfaction, and reserving the limited hospital beds for the truly sick. Because of this relationship with the UCC, our patients get better continuity of care.
Although the concept of the Acute Care Continuum seems like a new national hot topic, at SCVMC we have been practicing with the Acute Care Continuum in mind for years. Whether our patients need only a short-term fix or hospital admission, we see them post-discharge at one of our UCCs with a pre-scheduled appointment, our Express Care clinic, or as last resort at the ED. In addition, we have recently transitioned into a hospital-wide single electronic health care system, which is enabling us to work more closely with the other hospital departments and the UCC in real time. Ultimately, this has tremendously helped improve patient care, decreased the duplication of resources, and provided a cohesive treatment plan.
If the future does see patients pouring into the ED as Dr. Curry describes, so that private hospitals of tomorrow look like the county hospitals of today, then yes, there will be difficulties and hard work. Realistically, this is not easy. But from someone who has had the privilege of working with like-minded people who have done this for the majority of their careers, I have to say, it’s not bad. I have observed that they seem very happy and personally rewarded by the challenge. It’s why I wanted to be a doctor in the first place. Beyond the chaos of transitions and politics, at the end of every shift, I know that I have truly helped someone in need, and even “saved a life or two” in the Acute Care Continuum of today.