16 January 2015

Emergency Medicine’s Changing Role

In today’s healthcare landscape, it could be argued that “emergency department” is a misnomer for the typical ED. Emergencies happen, but the majority of patients come into the emergency department for more minor issues, or even just to be admitted to a department deeper within the hospital. In many hospitals, 60-80 percent of admitted patients come in through the emergency room, compared to 30-50 percent in decades past. Since more people are using this place as the point of entry to a hospital, patient satisfaction scores—and thus revenue—will increasingly depend on the patient experience in the emergency department.

Reasons for Emergency Medicine’s Changing Role

Though busy emergency rooms are often attributed to a large population of uninsured patients, a shift in how patients are diagnosed is also a contributing factor. Diagnostic technology has improved tremendously over the past few decades, and this quality improvement has been accompanied by increased cost. These costs are primarily a concern for Primary Care Physicians (PCPs): in cases where diagnostic tools are relatively cheap and low-tech, a private PCP can perform many of the same diagnostic procedures as the staff within the emergency department with a minimal investment in tools and instruments. But in cases where more expensive diagnostic devices are necessary – an MRI scanner, for example – achieving the same diagnostic sensitivity as an emergency department is cost prohibitive for PCPs. In effect, increased instrument costs have made it impossible for PCPs to achieve the sensitivity necessary to provide maximally accurate and legally defensible diagnoses for patients that present with certain symptoms.

Emergency departments, which have much more diagnostic and financial resources than private PCPs, have picked up the slack. Many now function as a sort of “rapid diagnosis and treatment center” – they serve, for all intents and purposes, as the general intake department for their hospital. The significant uninsured population, in concert with the continuing advancement of diagnostic technology, ensures that this trend will continue for years to come.

Prioritizing Patient Experience

The emergency department has become the starting point for diagnosis and care for emergency and non-critical patients alike. It has also become a patient’s first impression of his or her hospital experience. As Dr. Richard Petrik of Sheridan partner Ocala Regional Medical Center puts it: “If patients don’t have a good experience in the ER, they’re primed not to have a good experience on the inpatient side.”

The obvious metric influencing a patient’s experience in the emergency room is wait time. As patient volume increases, hospitals should evaluate their processes to identify any opportunities to cut down on door-to-provider times. Another area with room for improvement, says Dr. Petrik, is the communication between PCPs and ED physicians. As more primary care doctors send patients to the emergency room for further testing and evaluation, Dr. Petrik explains, a patient’s quality of care and time spent here can be greatly improved if the PCPs effectively communicate what they have learned in their initial meeting with a patient and what they had in mind when sending the patient to the emergency room. Better communication facilitates better care and ensures that a patient’s time isn’t wasted while emergency medicine physicians collect the same information the PCP already gleaned.

Small process changes can make a big difference in the patient experience, and increased patient volume means that these small improvements can quickly snowball into large benefits. As long as the emergency department continues to act as the “front door of the hospital,” making these shifts to better the patient experience will be of critical importance.