What lies ahead for the Patient Protection and Affordable Care Act
(PPACA)? Many wonder if it can or will be implemented and whether there
is any infrastructure to implement it. Another consideration is
Accountable Care Organizations (ACOs).
An in-depth look at how the Affordable Care Act will attempt to cut $1
trillion over the next two decades, and how it will present both
obstacles and opportunity for emergency medicine.
The Hawthorne Medical Center emergency department (ED) sees 50,000
patients each year. The fast track, open 16 hours a day, often sends
patients to the main ED when it shuts down at 1 AM. The staff is
convinced that adding another mid-level is the solution, although the
numbers indicate the current staffing should be adequate. Will adding a
mid-level solve their issue?
When Karen Sibert, an anesthesiologist with four children, wrote an
op/ed piece in the New York Times about the deleterious economical and
societal impact of physicians who choose to work part time, my email
inbox exploded. Comments were all over the place, from “You’ve gotta be
kidding,” to “Wonder if it would have been printed if a man wrote it,”
to “Raises some interesting points.”
A 21-year-old, right-hand dominant male without significant past medical
history, presents to your emergency department after a pallet of bricks
fell on his left, ring finger, while at work just prior to arrival.
His vaccinations are up to date. On exam, he has amputated his ring
finger just distal to the DIP joint, and bone is exposed at the site of
injury.You’re in small town U.S.A. No orthopedic service around. What do you do?
In recent years, the growth of emergency medicine around the globe has
been exponential, with nearly 70 countries now granting some form of
formal recognition to the field. At the same time, interest in Global
Emergency Medicine (GEM) as a unique subspecialty of emergency medicine
has also grown rapidly over the past decade.
The CDC reports that 123.8 million patients visited an emergency
department last year. That’s 41.4 visits per 100 population. That number
has risen every year despite numerous, concerted efforts by the
government and the insurance industry to stem the rising tide. Could it
be that patients see what the politicians and planners seem to be
missing, that the model of emergency care by qualified specialists, when
and only when you need it, is a good model for health care delivery?
Imagine you are the CEO of St. Elsewhere Hospital, which is a suburban
hospital with a 35,000 yearly visit emergency department (ED). The ED is
a mess: average door-to-doctor times of 110 minutes, a
left-without-being seen (LWBS) rate of 7%, and poor Press Ganey scores.
Most everyone in the hospital, including the patients, refer to it as
An emergency physician recently contacted me to tell me a story. It all
started when her local hospital emergency department received notice
that they were on an award list published by a well-known health care
grading company. “Terrific!” she said.
A patient is suffering from two life threatening events. Treatment for one condition may exacerbate the other condition. The standard of care is based upon a “reasonable person” standard, so I asked my friend what a reasonable doctor would do in the same or similar circumstances. He wasn’t sure.