Monday, February 11, 2008

Reinventing the ER

Since emergency medicine is near the top of my list of medical specialty choices, I often think about how the emergency room functions in the treatment of emergencies and, well, not-so-emergencies.

One way that hospitals are starting to address the challenge of caring for such diverse patients as car crash victims, IV drug users and uninsured folks with chronic disease is to stratify the care given after you walk through the door (or metal detector). For example, San Francisco General Hospital's free wound care clinic for IV drug users saves a lot of money by providing care there rather than in the expensive ER. By moving less urgent cases into a special care track, hospitals can save money and provide more appropriate care.

An article in today's NYTimes spins it a different way:
An increasing number are taking steps to bring civility and even hospitality to the emergency room, in part because, for all their turmoil, they remain vital points of entry for paying patients whose eventual admission accounts for needed revenue.
So not only is the ER a place to provide health care, it is the point of entry for revenue producing units - I mean patients. So we better make them happy or they will take their care (and reimbursements) elsewhere! Unfortunately the article focuses on remodeling costs and a laundry list of NY City ER's that are under construction.

There is great potential for improving the frontline care for uninsured and underinsured ER users. Sure, customer service reps are nice, but I am guessing that patients really just need problem-focused care. (Score one for family medicine!) If I go into emergency medicine, I want to be part of creative solutions to sorting what is a mixing pot of symptoms, diseases and emergency that keeps medicine affordable, but send patients home less likely to return.

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