Committee on the Future of Emergency Care in the United States. Health System ... recommendations and responsible entities for the entire report. This results in some ... physicians, including subspecialists in out-of-hospital and pediatric ...
BOOK AND MEDIA REVIEWS
Future of Emergency Care (3 volumes) Emergency Care for Children: Growing Pains Emergency Medical Services at the Crossroads Hospital-Based Emergency Care: At the Breaking Point Review by Steven L. Bernstein, MD
Tactical Emergency Medicine Review by Chad Kesler, MD and Trevor J. Mills, MD, MPH 0196-0644/$-see front matter Copyright © 2009 by the American College of Emergency Physicians.
Future of Emergency Care (3 volumes) Emergency Care for Children: Growing Pains Emergency Medical Services at the Crossroads Hospital-Based Emergency Care: At the Breaking Point Committee on the Future of Emergency Care in the United States Health System Institute of Medicine of the National Academies, 2006 1020 pages (3 volumes), $102.74 ISBN 10:0-309-10825-X, 13:978-0-309-10825-6 The year 1970 was a watershed one for emergency medicine. In Cincinnati, the specialty’s first residency began. In Washington, DC, the National Academies founded the Institute of Medicine (IOM), which, 36 years later, would issue 3 landmark reports addressing the current and future state of emergency care in the United States. These reports represent the culmination of 3 years’ work by 40 committee and subcommittee members who met 19 times, heard testimony from 60 speakers, commissioned 11 research papers, and conducted hundreds of site visits and interviews. These reports provide the definitive word on the history, current status, and future of emergency care in the US. The Future of Emergency Care consists of 3 volumes, organized along similar lines. Each has chapters devoted to introduction, history, building a 21st century emergency care system, workforce issues, quality of care and infrastructure, disaster preparedness, and research. Each ends with a helpful series of appendices, including a table summarizing the recommendations and responsible entities for the entire report. This results in some redundancy of content and recommendations, although each text easily stands on its own. Several themes and recommendations run through the reports, including the need to coordinate and regionalize emergency care, enhance operational efficiency across the entire emergency care system, enhance the use of information technology, provide funding for uncompensated care, improve provider training and education, and expand the research base. Of note, the report calls for Congress to establish a new agency, housed within the Department of Health and Human Services, to coordinate emergency and trauma care. (As of August 2008, this has yet to happen.) Volume , . : April
Although each volume will be of interest to all emergency physicians, including subspecialists in out-of-hospital and pediatric emergency care, the volume devoted to hospital-based emergency care may find the widest audience. This report begins by noting the explosive growth in US ED volume—26% from 1993-2003— coupled with the closure of 703 hospitals and 425 EDs. This volume contains a clarion call to end the practice of boarding admitted patients in the ED by noting its effects on quality of care, the potential risk for error, treatment delays, and worsening of the work environment for ED staff. This recommendation will be welcomed by all emergency care providers, along with this report’s discussion of potential solutions, including implementation of full capacity protocols, alignment of financial incentives, and adoption by The Joint Commission of strong standards designed to reduce crowding. These reports have already had an impact in the policy, educational, and research arenas. Congressman Stark of the House Ways and Means Committee has held hearings, the National Institutes of Health is soliciting input for future emergency care research, the Government Accountability Office is studying ED crowding, the National Quality Forum is developing quality standards for emergency care, and the American College of Emergency Physicians and the Society for Academic Emergency Medicine are working with the Agency for Healthcare Research and Quality to develop a conference devoted to emergency care. For interested readers, in 2007 the IOM published a companion volume summarizing the results of a series of nationwide dissemination workshops, and the initial presentations made to the committee are available at the IOM Web site, www.iom.edu. These books deserve a place on the shelf of every emergency physician, and every administrator, policymaker, and researcher involved with emergency care. Emergency physicians, and the patients we care for, owe the IOM a considerable debt of gratitude. Steven L. Bernstein, MD Section of Emergency Medicine Yale University School of Medicine New Haven, CT doi:10.1016/j.annemergmed.2008.09.021
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