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Moving Emergency Care Systems Forward

Moving Emergency Care Systems Forward

Emergency care is an essential component of healthcare delivery in the United States but remains outdated and fragmented. A common sense approach to increasing the value of emergency care delivery is to develop regionalized integrated networks by taking advantage of market, financial, and technological changes to achieve a critical shift in emergency care. Instead of getting time-sensitive patients to the right place at the right time, regional networks can focus on delivering the right resources to patients at the right place, right time, and right cost. The delivery of care at specialty centers has grown in recent years but has resulted in some unintended consequences. Specialty evaluation resources and capabilities have become concentrated at urban specialty centers and hospitals with higher volumes than smaller, suburban, and rural hospitals. Over time, smaller hospitals have needed to unnecessarily transfer many local patients to bigger facilities for further evaluation. This can increase unnecessary costs, delay care, lead to a loss of capabilities, and undermine financial viability. With changing demands and payment models, the continuum of emergency care must be transformed to provide high-quality care at lower costs and across distances. A New, More Integrated Model To replace our fragmented system, a web of interconnected but separate hospitals and providers should be developed. These institutions should have shared quality and performance goals and incentives to improve outcomes across conditions, levels of acuity, and facilities. This type of integrated system can dramatically change day-to-day care delivery and improve local, regional, and national abilities to respond to public health emergencies. Real-time telemedicine interfaces and communications can be used to facilitate specialty care to places that...
Substance Use Disorders Among Emergency Physicians

Substance Use Disorders Among Emergency Physicians

The prevalence of substance use disorders among physicians ranges between 10% and 14%, a rate that is similar to that of the general population. “Research has shown that several specialties have a higher-than-expected rate of these disorders, most notably anesthesiology, emergency medicine, and psychiatry,” says John S. Rose, MD. Despite the reported higher rates of substance use disorders and participation in Physician Health Programs (PHPs) among these specialties, few studies have focused specifically on the prognosis and recovery of emergency physicians (EPs) in PHPs. Important New Data There are little data on whether EPs who receive treatment by PHPs have similar outcomes with these programs as other physicians. To address this research gap, Dr. Rose and colleagues conducted a study using data from 16 state PHPs that followed participants with substance use disorders for 5 or more years. Published in the Western Journal of Emergency Medicine, the study compared outcomes of EPs with other practitioners who were enrolled in state PHPs. “Research has been limited regarding whether EPs perform as well as other physicians after treatment from PHPs,” Dr. Rose says. “We wanted to determine if there were any characteristics for EPs that were significantly different from those of other physicians.” For the study, investigators reviewed data on 904 physicians with a diagnosis of substance use disorders between 1995 and 2001. They compared 56 EPs with 724 other physicians and assessed rates of relapse, successful completion of monitoring, and return to clinical practice within 5 years. Overall, EPs had a higher-than-expected rate of substance use disorders. “EPs were almost three times as likely to be enrolled in a PHP...
Safe Harbor for Docs  Who Follow Guidelines

Safe Harbor for Docs Who Follow Guidelines

Physician leaders are supporting a new proposed federal law that aims to reduce litigation against physicians, lower healthcare costs, and establish more fairness in the analyzing of malpractice claims. The new House bill, Saving Lives, Saving Costs Act, introduced by Congressmen Andy Barr (R-KY) and Ami Bera, MD, (D-CA) would create “safe harbor” – protection from liability – for physicians who follow best practice guidelines from malpractice suits. More than 75% of physicians face a malpractice claim over the course of their career—a liability climate that can drive patient care and encourage overutilization, adding billions of dollars in health costs each year. And patient outcomes don’t appear to improve as a result. If the physician being sued argues that he or she adhered to relevant, best practice guidelines, the case will be put in front of an independent medical review panel for investigation. If the panel determines that the clinician did comply to the guidelines or that the injury was not caused by failure to comply, the case will be dismissed. Personal injury lawyers are pushing back, one in particular claiming: “There is no evidence, however, that this safe harbor would actually promote patient safety. In fact, in Texas, where emergency room physicians have had immunity since 2003, patient safety has steadily decreased.” The Center for Justice and Democracy argues that clinical practice guidelines should not be used as a legal basis for determining negligence. The organization claims that there is already a general recognition that conflict of interest and specialty bias are ongoing problems in the development of clinical practice guidelines. Other concerns include the numerous, and sometimes contradictory, guidelines...
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