As an emergency physician, I know that I have the best job in the world. When I was a new attending, I started each day with anticipation, wondering who and what would walk through the department’s doors. I lived for true emergencies, awed by our team’s ability to save lives. And even when treating more routine complaints, I was proud to provide a safety net to some of our most vulnerable patients.
At the same time, it was hard to ignore the enormous challenges facing emergency medicine. As I matured, I realized that health disparities, prohibitive costs, long waits, and lack of care continuity were harming the patients I most wanted to help. I took a series of leadership positions, determined to help patch the ever-expanding cracks in the system. While we made some progress over the years, change came slowly and usually in small, stepwise doses.
The urgency of the coronavirus pandemic is opening new windows for change. At long last, we have an opportunity to make care more accessible, affordable, and compassionate. In this post, I’ll share some positive trends in emergency medicine that need to gain traction over the next few years.
Since the dawn of emergency medicine in the mid-1970s, patients have traveled to EDs for care. This delivery model persisted even as departments began delivering more urgent and primary care. Urgent care medicine increased accessibility but still excluded many patients who could not cover its costs.
Now, after 50 years, this costly paradigm may finally be shifting. Instead of putting the responsibility on patients to choose the best care setting, health systems are stepping up to help them navigate the maze.
Many are investing in solutions that allow patients to begin virtual ED visits at home. In some cases, emergency physicians can treat patients entirely by videoconference. When appropriate, they can also direct patients to the ED or an urgent care center.
Extending emergency medicine beyond the department’s walls has many benefits, including:
Janet Young, MD
One of the most frustrating aspects of emergency medicine is the limited impact we have on patients’ health. While we can save lives, long-term outcomes depend on the patients accessing appropriate follow-up care.
Historically, care continuity hasn’t been emergency medicine’s strong suit. In the past, we'd simply hand patients their paperwork after ruling out any acute issues and tell them to follow up with their primary care doctors. But what happens to patients who don’t have a primary care physician? So many have fallen through the cracks.
These transitions are further complicated during the pandemic, when many people come to the ED alone. I am constantly humbled to see the difference family can make in a patient’s care. In addition to providing moral support, loved ones often serve as an extra set of eyes and ears. Today more than ever, I believe it’s crucial for emergency medicine providers to connect to our vulnerable patients’ support systems. For me, this means calling parents, spouses, and children on every shift—some of whom are waiting anxiously in the parking lot. Despite taking a little more time, this small gesture has alleviated fears and helped me to provide better, more compassionate care.
Many ED teams already call back discharged patients who are at risk or lack primary care access. Some providers are now going one step further and making the callback a virtual follow-up visit. This provides incredible value to patients who may not have access to their pre-pandemic providers, clinics, and resources.
Other EDs are using telenavigation to improve care continuity. Navigators work with patients to schedule needed follow-up appointments. They can also connect them with community resources that assist with housing, utilities, food, and other necessities.
Improving ED care continuity benefits everyone involved. Providers are more comfortable discharging patients who have reliable access to follow-up care. For the patient, this means returning to the comforts of home and family. For hospitals, it creates a more efficient patient flow and builds community loyalty.
While the dangers of the pandemic are real, it’s also a rewarding time to enter emergency medicine. Most emergency physicians spend 11-12 years in training. After that, we want to be able to deliver great care that uses our unique skillset.
Of course, the shift to virtual care will demand new skills and attitudes. Among my colleagues, technology adoption seems to cause the most anxiety. However, I believe our biggest cultural shifts will involve communication skills and rapport.
Fair or not, emergency medicine providers have a less than stellar rep for bedside manner and customer service. In a way, it’s totally understandable; the niceties may slip when you’re racing to a code. But the truth is, we really can’t afford to be tone-deaf in a telehealth visit when we need to quickly win trust through a screen. Virtual care demands a warmer, more empathic approach that will require many of us to adapt.
However, our efforts will likely be rewarded in the form of improved work-life balance. As we shift to mixed virtual and in-person care, expect to see more flexible schedules and work-at-home arrangements. In addition, many virtual care platforms integrate with the hospital EHR, which eases providers’ paperwork and administrative burdens. Maybe I will finally have time to help my kid with chemistry.
In these challenging times, Vituity is seizing the opportunity to improve ED care delivery, collaborating with our health system partners to innovate care beyond the hospital walls.
During the early days of the pandemic, urgency among ED providers sparked a tidal wave of innovation. Front-line clinical teams designed new processes to control infection and conserve personal protective equipment. They also leveraged technology to extend emergency care into patients’ homes. Just a few innovative solutions that emerged from this period:
While the coronavirus pandemic has brought many challenges to my practice, it’s also ushered in fresh hope. I’m often reminded of my new-attending self, who was simply thrilled to be of service. Now the optimist in me looks forward to a not-so-distant future when instead of just providing my ED patients with a huge stack of paperwork following treatment, I can offer them an integrated road map to lasting health.
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