ER physicians can help meet the triple aim

It is amazing to me how far emergency medicine has come as a specialty. Until the 1970s, emergency rooms were staffed by low-level resident interns who moonlighted for extra money or physicians who couldn’t find work elsewhere. After finally getting recognized as a specialty, the specialty still spent a few decades finding its way: developing training programs, improving quality, and generally trying to raise the bar on emergency care in the U.S.

Fast forward to today. Big strides have been made in cardiac, stroke, and critical care. ER physicians have improved technologies such as ultrasound and have advanced the field of airway management. Emergency departments have served as a testing ground for patient queuing and improved efficiencies in patient throughput. Emergency physicians are no longer low-level residents fighting for a seat at the table, but truly are experts at emergency care whose presence at the table is vital.  In short, emergency physicians have arrived.

This realization came to a head recently as I was sitting in a hospital boardroom for a meeting. The topic was the triple aim: improving patient experience, improving the health of populations and reducing the per capita cost of health care.

This is a conversation that most hospitals are having as the health care system moves to being based on value instead of volume. No longer are the priorities to simply keep our hospital beds full and our operating rooms and cath labs busy. Rather, the question now is, “Are we providing the right care, rather than the most care?”

There are other questions, too: “Are patients better served in the outpatient setting rather than the inpatient?”  “How can we coordinate services with primary physicians and specialists in the community to prevent unnecessary hospital stays?”  “Are we addressing end of life care?”  “How can we improve utilization of imaging studies to patients and not compromise quality?”  Hospitals need answers to all of these. The idea of a value-based system of health care, which seemed like a nice conversation piece for cocktail parties not too long ago, is now a central part of our health care agenda.

Emergency physicians are central players in answering these questions, and a hospital’s success in integrating care will be driven squarely by the care that is provided in the emergency department. It’s an exciting time to be in the field of emergency medicine. The decisions that emergency physicians make over the coming years will have a real and lasting impact on the future health care system.

I am happy that we are finally asking the right questions — but happier still that we emergency physicians are the ones to be answering them.

Vipul Kella is is an emergency physician who blogs at The Shift.

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