Many of the 32 million Americans set to receive health insurance for the first time have historically used the emergency department in place of a primary care provider. John Fontanetta, MD, chairman of the emergency department at Clara Maass Medical Center in Belleville, N.J., and CMO for EDIMS, discusses four ways EDs are changing to accommodate health reform laws and increased patient load.
1. Emergency department volumes will rise. Although the rhetoric of healthcare reform might imply that universal coverage will alleviate the burden on emergency departments, Dr. Fontanetta anticipates increased growth in ED volumes over the next few years. "Even though some people go to emergency departments because they can't find care anywhere else, most ED visits are appropriate visits," he says. "People come to EDs because it's more convenient and provides more appropriate, quicker care. By insuring an additional 30 million people in this country, it makes sense that ED volumes will increase."
Instead of attempting to lower patient volume in the emergency department, Dr. Fontanetta says hospitals will have to transform to offer more emergency care. The hospital of the future, in his mind, will contain a very large ED on the ground floor with an intensive care unit and operating rooms on the upper floors. "More and more, emergency departments are being called upon to provide a lot of care that we are accepting as primary care in the EDs, and a well-run ED can actually provide some of this care in a very cost-effective way," he says.
2. EDs will have to strengthen relationships with other providers. Although emergency departments might not be able to lower the number of patients who come to the ED for legitimate emergencies, hospitals can make an effort to route patients to a primary care physician after their ED visit is over. "Most physicians don't have an issue with the number of patients coming to the ED for care," Dr. Fontanetta says. "Their more pressing need is to have somewhere to send the patient after that." If a patient comes to the ED with a minor complaint, emergency department physicians can certainly treat or observe the patient. The most important step following health reform is to develop strong relationships between hospital emergency departments and primary care physicians.
The problem isn't high volume or inadequate care, Dr. Fontanetta says. "When patients use EDs for primary care, they lose out on the preventative care over time that EDs don't provide," he says. "If a child comes in with an earache, we can take care of it, but we're not necessarily checking on their growth or other factors that [PCPs] would look at."
3. Fast-track areas will become essential to dealing with minor complaints. Over the last ten years, Dr. Fontanetta says most EDs have created "fast track areas," or areas in the emergency department that take care of lower-acuity problems that could be cared for in a primary care office. "If you use the standard emergency procedures and take care of patients relative to seriousness, the patients with a minor complaint are never seen," says Dr. Fontanetta. "By creating fast track areas, you can actually cater to those minor complaints if the areas operate independently of the main ED and are staffed specially." He emphasizes that the answer is not to turn patients away. Patients turned away from the ED will most likely ignore a minor complaint rather than seek out a primary care physician, and the hospital's highest priority is to protect the patient.
4. Observation areas will allow physicians to determine whether patients need admitting. The government is tightening the regulations on "appropriate admissions" for the emergency department, so hospitals will not be reimbursed for providing emergency care to a patient suffering from a non-emergency issue. The problem is that admissions aren't black and white. A physician might recognize a patient is in distress but feel unsure if their condition qualifies as an "emergency" for reimbursement. In this case, many hospitals are adding observation areas to their emergency departments, so physicians can monitor a patient's condition and then make an informed decision about whether to admit them or send them home. "If a patient comes in for a problem like asthma, the answer may not be to admit that patient, but to observe them in the ED for 24 hours to ensure they're over their asthma attack," Dr. Fontanetta says.
1. Emergency department volumes will rise. Although the rhetoric of healthcare reform might imply that universal coverage will alleviate the burden on emergency departments, Dr. Fontanetta anticipates increased growth in ED volumes over the next few years. "Even though some people go to emergency departments because they can't find care anywhere else, most ED visits are appropriate visits," he says. "People come to EDs because it's more convenient and provides more appropriate, quicker care. By insuring an additional 30 million people in this country, it makes sense that ED volumes will increase."
Instead of attempting to lower patient volume in the emergency department, Dr. Fontanetta says hospitals will have to transform to offer more emergency care. The hospital of the future, in his mind, will contain a very large ED on the ground floor with an intensive care unit and operating rooms on the upper floors. "More and more, emergency departments are being called upon to provide a lot of care that we are accepting as primary care in the EDs, and a well-run ED can actually provide some of this care in a very cost-effective way," he says.
2. EDs will have to strengthen relationships with other providers. Although emergency departments might not be able to lower the number of patients who come to the ED for legitimate emergencies, hospitals can make an effort to route patients to a primary care physician after their ED visit is over. "Most physicians don't have an issue with the number of patients coming to the ED for care," Dr. Fontanetta says. "Their more pressing need is to have somewhere to send the patient after that." If a patient comes to the ED with a minor complaint, emergency department physicians can certainly treat or observe the patient. The most important step following health reform is to develop strong relationships between hospital emergency departments and primary care physicians.
The problem isn't high volume or inadequate care, Dr. Fontanetta says. "When patients use EDs for primary care, they lose out on the preventative care over time that EDs don't provide," he says. "If a child comes in with an earache, we can take care of it, but we're not necessarily checking on their growth or other factors that [PCPs] would look at."
3. Fast-track areas will become essential to dealing with minor complaints. Over the last ten years, Dr. Fontanetta says most EDs have created "fast track areas," or areas in the emergency department that take care of lower-acuity problems that could be cared for in a primary care office. "If you use the standard emergency procedures and take care of patients relative to seriousness, the patients with a minor complaint are never seen," says Dr. Fontanetta. "By creating fast track areas, you can actually cater to those minor complaints if the areas operate independently of the main ED and are staffed specially." He emphasizes that the answer is not to turn patients away. Patients turned away from the ED will most likely ignore a minor complaint rather than seek out a primary care physician, and the hospital's highest priority is to protect the patient.
4. Observation areas will allow physicians to determine whether patients need admitting. The government is tightening the regulations on "appropriate admissions" for the emergency department, so hospitals will not be reimbursed for providing emergency care to a patient suffering from a non-emergency issue. The problem is that admissions aren't black and white. A physician might recognize a patient is in distress but feel unsure if their condition qualifies as an "emergency" for reimbursement. In this case, many hospitals are adding observation areas to their emergency departments, so physicians can monitor a patient's condition and then make an informed decision about whether to admit them or send them home. "If a patient comes in for a problem like asthma, the answer may not be to admit that patient, but to observe them in the ED for 24 hours to ensure they're over their asthma attack," Dr. Fontanetta says.