|
Items in cart [0] |
Questions? Call 888-624-8373 |
| Copyright © 2009. National Academy of Sciences. All rights reserved. Terms of Use and Privacy Statement |
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page R1
Hospital-Based Emergency Care: At the Breaking Point
FUTURE OF EMERGENCY CARE
HOSPITAL-BASED EMERGENCY CARE
AT THE BREAKING POINT
Committee on the Future of Emergency Care in the United States Health System
Board on Health Care Services
INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
OCR for page R2
Hospital-Based Emergency Care: At the Breaking Point
THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract No. 282-99-0045 between the National Academy of Sciences and the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ); Contract No. B03-06 between the National Academy of Sciences and the Josiah Macy, Jr. Foundation; and Contract No. HHSH25056047 between the National Academy of Sciences and the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) and Centers for Disease Control and Prevention (CDC), and the U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
Library of Congress Cataloging-in-Publication Data
Hospital-based emergency care : at the breaking point / Committee on the Future of Emergency Care in the United States Health System, Board on Health Care Services.
p. ; cm. — (Future of emergency care series)
Includes bibliographical references and index.
ISBN-13: 978-0-309-10173-8 (hardback)
ISBN-10: 0-309-10173-5 (hardback)
1. Hospitals—Emergency services. 2. Emergency medical services. I. Institute of Medicine (U.S.). Committee on the Future of Emergency Care in the United States Health System. II. Series.
[DNLM: 1. Emergency Service, Hospital—United States. 2. Health Care Reform—United States. WX 215 H8261 2007]
RA975.5.E5H67723 2007
362.11—dc22
2007000079
Additional copies of this report are available from the
National Academies Press,
500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.
Copyright 2007 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
OCR for page R3
Hospital-Based Emergency Care: At the Breaking Point
“Knowing is not enough; we must apply. Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
OCR for page R4
Hospital-Based Emergency Care: At the Breaking Point
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.
www.national-academies.org
OCR for page R5
Hospital-Based Emergency Care: At the Breaking Point
COMMITTEE ON THE FUTURE OF EMERGENCY CARE IN THE UNITED STATES HEALTH SYSTEM
GAIL L. WARDEN (Chair), President Emeritus,
Henry Ford Health System, Detroit, Michigan
STUART H. ALTMAN, Sol C. Chaikin Professor of National Health Policy,
Heller School of Social Policy, Brandeis University, Waltham, Massachusetts
BRENT R. ASPLIN, Associate Professor of Emergency Medicine, University of Minnesota and Department Head,
Regions Hospital Emergency Department, St. Paul
THOMAS F. BABOR, Chair,
Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington
ROBERT R. BASS, Executive Director,
Maryland Institute for Emergency Medical Services Systems, Baltimore
BENJAMIN K. CHU, Regional President,
Southern California, Kaiser Foundation Health Plan and Hospital, Pasadena
A. BRENT EASTMAN, Chief Medical Officer, N. Paul Whittier Chair of Trauma,
ScrippsHealth, San Diego, California
GEORGE L. FOLTIN, Director, Center for Pediatric Emergency Medicine, Associate Professor of Pediatrics and Emergency Medicine,
New York University School of Medicine, Bellevue Hospital Center, New York
SHIRLEY GAMBLE, Chief Operating Officer,
United Way Capital Area, Austin, Texas
DARRELL J. GASKIN, Associate Professor,
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
ROBERT C. GATES, Project Director,
Medical Services for Indigents, Health Care Agency, Santa Ana, California
MARIANNE GAUSCHE-HILL, Clinical Professor of Medicine and Director,
Prehospital Care, Harbor-UCLA Medical Center, Torrance, California
JOHN D. HALAMKA, Chief Information Officer,
Beth Israel Deaconess Medical Center, Boston, Massachusetts
MARY M. JAGIM,
Internal Consultant for Emergency Preparedness Planning, MeritCare Health System, Fargo, North Dakota
ARTHUR L. KELLERMANN, Professor and Chair, Department of Emergency Medicine and Director,
Center for Injury Control, Emory University School of Medicine, Atlanta, Georgia
WILLIAM N. KELLEY, Professor of Medicine,
Biochemistry & Biophysics, University of Pennsylvania School of Medicine, Philadelphia
OCR for page R6
Hospital-Based Emergency Care: At the Breaking Point
PETER M. LAYDE, Professor and Interim Director, Health Policy Institute and Co-Director,
Injury Research Center, Medical College of Wisconsin, Milwaukee
EUGENE LITVAK, Professor of Health Care and Operations Management Director,
Program for Management of Variability in Health Care Delivery, Boston University Health Policy Institute, Massachusetts
RICHARD A. ORR, Associate Director, Cardiac Intensive Care Unit, Medical Director, Children’s Hospital Transport Team of Pittsburgh and Professor,
University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pennsylvania
JERRY L. OVERTON, Executive Director,
Richmond Ambulance Authority, Virginia
JOHN E. PRESCOTT, Dean,
West Virginia University School of Medicine, Morgantown
NELS D. SANDDAL, President,
Critical Illness and Trauma Foundation, Bozeman, Montana
C. WILLIAM SCHWAB, Professor of Surgery, Chief,
Division of Traumatology and Surgical Critical Care, Department of Surgery, University of Pennsylvania Medical Center, Philadelphia
MARK D. SMITH, President and CEO,
California Healthcare Foundation, Oakland
DAVID N. SUNDWALL, Executive Director,
Utah Department of Health, Salt Lake City
OCR for page R7
Hospital-Based Emergency Care: At the Breaking Point
SUBCOMMITTEE ON HOSPITAL-BASED EMERGENCY CARE
BENJAMIN K. CHU (Chair), Regional President,
Southern California, Kaiser Foundation Health Plan and Hospital, Pasadena
STUART H. ALTMAN, Sol C. Chaikin Professor of National Health Policy,
Heller School of Social Policy, Brandeis University, Waltham,Massachusetts
BRENT R. ASPLIN, Associate Professor of Emergency Medicine,
University of Minnesota and Department Head, Regions Hospital Emergency Department, St. Paul
JOHN D. HALAMKA, Chief Information Officer,
Beth Israel Deaconess Medical Center, Boston, Massachusetts
MARY M. JAGIM,
Internal Consultant for Emergency Preparedness Planning, MeritCare Health System, Fargo, North Dakota
KENNETH W. KIZER, President, Chief Executive Officer, and Chairman,
Medsphere Systems Corporation, Aliso Viejo, California
PETER M. LAYDE, Professor and Interim Director, Health Policy Institute and Co-Director,
Injury Research Center, Medical College of Wisconsin, Milwaukee
EUGENE LITVAK, Professor of Health Care and Operations Management Director,
Program for Management of Variability in Health Care Delivery, Boston University Health Policy Institute, Massachusetts
JOHN R. LUMPKIN, Senior Vice President,
The Robert Wood Johnson Foundation, Princeton, New Jersey
W. DANIEL MANZ, Director,
Emergency Medical Services Division, Vermont Department of Health, Burlington
JOHN E. PRESCOTT, Dean,
West Virginia University School of Medicine, Morgantown
C. WILLIAM SCHWAB, Professor of Surgery, Chief,
Division of Traumatology and Surgical Critical Care, Department of Surgery, University of Pennsylvania Medical Center, Philadelphia
JOSEPH L. WRIGHT, Executive Director,
Child Health Advocacy Institute, Children’s National Medical Center;
Professor of Pediatrics,
Emergency Medicine & Community Health, George Washington University Schools of Medicine and Public Health, Washington, District of Columbia; and
State EMS Medical Director for Pediatrics,
Maryland Institute for Emergency Medical Services Systems, Baltimore
Study Staff
ROBERT B. GIFFIN, Study Co-Director and Senior Program Officer
SHARI M. ERICKSON, Study Co-Director and Program Officer
MEGAN MCHUGH, Senior Program Officer
OCR for page R8
Hospital-Based Emergency Care: At the Breaking Point
BENJAMIN WHEATLEY, Program Officer
ANISHA S. DHARSHI, Research Associate
SHEILA J. MADHANI, Program Officer
CANDACE TRENUM, Senior Program Assistant
OCR for page R9
Hospital-Based Emergency Care: At the Breaking Point
Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
E. JOHN GALLAGHER, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
KRISTINE M. GEBBIE, Center for Health Policy, Columbia University School of Nursing, New York, New York
LEWIS R. GOLDFRANK, Department of Emergency Medicine, New York University School of Medicine, New York University Medical Center and Bellevue Hospital Center, New York
JERRIS R. HEDGES, School of Medicine, Oregon Health & Science University, Portland
GARY JOHNSON, Department of Family Medicine, University of Nevada School of Medicine, Reno
OCR for page R10
Hospital-Based Emergency Care: At the Breaking Point
D. RANDY KUYKENDALL, Emergency Medical and Trauma Services Section, Health Facilities & Emergency Medical Services Division, Colorado Department of Public Health & Environment, Colorado Springs
RONALD V. MAIER, Department of Surgery, Harborview Medical Center, Seattle, Washington
MITCHELL T. RABKIN, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
SARA ROSENBAUM, Department of Health Policy, School of Public Health and Health Services, The George Washington University Medical Center, Washington, District of Columbia
ALEX B. VALADKA, Department of Neurological Surgery, University of Texas Medical School at Houston
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Enriqueta C. Bond, Burroughs Wellcome Fund, and Don E. Detmer, American Medical Informatics Association. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
OCR for page R11
Hospital-Based Emergency Care: At the Breaking Point
Foreword
The state of emergency care affects every American. When illness or injury strikes, Americans count on the emergency care system to respond with timely and high-quality care. Yet today, the emergency and trauma care that Americans receive can fall short of what they expect and deserve.
Emergency care is a window on health care, revealing both what is right and what is wrong with the care delivery system. Americans increasingly rely on hospital emergency departments because of the skilled specialists and advanced technologies they offer. At the same time, the increasing use of the emergency care system represents failures of the larger health care system—the growing numbers of uninsured Americans, the limited alternatives available in many communities, and the inadequate preventive care and chronic care management received by many. The resulting demands on the system can degrade the quality of emergency care and hinder the ability to provide urgent and lifesaving care to seriously ill and injured patients wherever and whenever they need it.
The Committee on the Future of Emergency Care in the United States Health System, ably chaired by Gail Warden, set out to examine the emergency care system in the United States; explore its strengths, limitations, and future challenges; describe a desired vision of the emergency care system; and recommend strategies required to achieve that vision. Their efforts build on past contributions of the National Academies, including the landmark National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society in 1966, Injury in America: A Continuing Public Health Problem in 1985, and Emergency Medical Services for Children in 1993.
OCR for page R16
Hospital-Based Emergency Care: At the Breaking Point
acts of terrorism. During any such event, local hospitals and emergency departments will be on the front lines. Yet of the millions of dollars going into preparedness efforts, a tiny fraction has made its way to medical preparedness, and much of that has focused on one of the least likely threats—bioterrorism. The result is that few hospital and EMS professionals have had even minimal disaster preparedness training; even fewer have access to personal protective equipment; hospitals, many already stretched to the limit, lack the ability to absorb any significant surge in casualties; and supplies of critical hospital equipment, such as decontamination showers, negative pressure rooms, ventilators, and intensive care unit beds, are wholly inadequate. A system struggling to meet the day-to-day needs of the public will not have the capacity to deal with a sustained surge of patients.
FRAMEWORK FOR THIS STUDY
This year marks the fortieth anniversary of the publication of the landmark National Academy of Sciences/National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society. That report described an epidemic of automobile-related and other injuries, and harshly criticized the deplorable state of trauma care nationwide. The report prompted a public outcry, and stimulated a flood of public and private initiatives to enhance highway safety and improve the medical response to injuries. Efforts included the development of trauma and prehospital EMS systems, creation of the specialty in emergency medicine, and establishment of federal programs to enhance the emergency care infrastructure and build a research base. To many, the 1966 report marked the birth of the modern emergency care system.
Since then, the National Academies and the Institute of Medicine (IOM) have produced a variety of reports examining various aspects of the emergency care system. The 1985 report Injury in America called for expanded research into the epidemiology and treatment of injury, and led to the development of the National Center for Injury Prevention and Control within the Centers for Disease Control and Prevention. The 1993 report Emergency Medical Services for Children exposed the limited capacity of the emergency care system to address the needs of children, and contributed to the expansion of the EMS-C program within the Department of Health and Human Services. It has been 10 years, however, since the IOM examined any aspect of emergency care in depth. Furthermore, no National Academies report has ever examined the full range of issues surrounding emergency care in the United States.
OCR for page R17
Hospital-Based Emergency Care: At the Breaking Point
That is what this committee set out to do. The objectives of the study were to (1) examine the emergency care system in the United States; (2) explore its strengths, limitations, and future challenges; (3) describe a desired vision for the system; and (4) recommend strategies for achieving this vision.
STUDY DESIGN
The IOM Committee on the Future of Emergency Care in the United States Health System was formed in September 2003. In May 2004, the committee was expanded to comprise a main committee of 25 members and three subcommittees. A total of 40 main and subcommittee members, representing a broad range of expertise in health care and public policy, participated in the study. Between 2003 and 2006, the main committee and subcommittees met 19 times; heard public testimony from nearly 60 speakers; commissioned 11 research papers; conducted site visits; and gathered information from hundreds of experts, stakeholder groups, and interested individuals.
The magnitude of the effort reflects the scope and complexity of emergency care itself, which encompasses a broad continuum of services that includes prevention and bystander care; emergency calls to 9-1-1; dispatch of emergency personnel to the scene of injury or illness; triage, treatment, and transport of patients by ambulance and air medical services; hospital-based emergency and trauma care; subspecialty care by on-call specialists; and subsequent inpatient care. Emergency care’s complexity can also be traced to the multiple locations, diverse professionals, and cultural differences that span this continuum of services. EMS, for example, is unlike any other field of medicine—over one-third of its professional workforce consists of volunteers. Further, EMS has one foot in the public safety realm and one foot in medical care, with nearly half of all such services being housed within fire departments. Hospital-based emergency care is also delivered by an extraordinarily diverse staff—emergency physicians, trauma surgeons, critical care specialists, and the many surgical and medical subspecialists who provide services on an on-call basis, as well as specially trained nurses, pharmacists, physician assistants, nurse practitioners, and others.
The division into a main committee and three subcommittees made it possible to break down this enormous effort into several discrete components. At the same time, the committee sought to examine emergency care as a comprehensive system, recognizing the interdependency of its component parts. To this end, the study process was highly integrated. The main committee and three subcommittees were designed to provide for substantial overlap, interaction, and cross-fertilization of expertise. The committee concluded that nothing will change without cooperative and visionary lead-
OCR for page R18
Hospital-Based Emergency Care: At the Breaking Point
ership at many levels and a concerted national effort among the principal stakeholders—federal, state, and local officials; hospital leadership; physicians, nurses, and other clinicians; and the public.
The committee hopes that the reports in the Future of Emergency Care series will stimulate increased attention to and reform of the emergency care system in the United States. I wish to express my appreciation to the members of the committee and subcommittees and the many panelists who provided input at the meetings held for this study, and to the IOM staff for their time, effort, and commitment to the development of these important reports.
Gail L. Warden
Chair
OCR for page R19
Hospital-Based Emergency Care: At the Breaking Point
Acknowledgments
The Future of Emergency Care series benefited from the contributions of many individuals and organizations. The committee and Institute of Medicine (IOM) staff take this opportunity to recognize and thank those who helped in the development of the reports in the series.
A large number of individuals assembled materials that helped the committee develop the evidence base for its analyses. The committee appreciates the contributions of experts from a variety of organizations and disciplines who gave presentations during committee meetings or authored papers that provided information incorporated into the series of reports. The full list of presenters is provided in Appendix C. Authors of commissioned papers are listed in Appendix D.
Committee members and IOM staff conducted a number of site visits throughout the course of the study to gain a better understanding of certain aspects of the emergency care system. We appreciate the willingness of staff from the following organizations to meet with us and respond to questions: Beth Israel Deaconess Medical Center, Boston Medical Center, Children’s National Medical Center, Grady Memorial Hospital, Johns Hopkins Hospital, Maryland Institute for EMS Services Systems, Maryland State Police Aviation Division, Richmond Ambulance Association, and Washington Hospital Center.
We would also like to express appreciation to the many individuals who shared their expertise and resources on a wide range of issues: Karen Benson-Huck, Linda Fagnani, Carol Haraden, Lenworth Jacobs, Tom Judge, Nadine Levick, Ellen MacKenzie, Dawn Mancuso, Rick Murray, Ed
OCR for page R20
Hospital-Based Emergency Care: At the Breaking Point
Racht, Dom Ruscio, Carol Spizziri, Caroline Steinberg, Rosemary Stevens, Peter Vicellio, and Mike Williams.
This study received funding from the Josiah Macy, Jr. Foundation, the National Highway Traffic Safety Administration (NHTSA), and three agencies within the Department of Health and Human Services: the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA). We would like to thank the staff from those organizations who provided us with information, documents, and insights throughout the project, including Drew Dawson, Laurie Flaherty, Susan McHenry, Gamunu Wijetunge, and David Bryson of NHTSA; Dan Kavanaugh, Christina Turgel, and David Heppel of HRSA; Robin Weinick and Pam Owens of AHRQ; Rick Hunt and Bob Bailey from CDC’s National Center for Injury Prevention and Control; and many other helpful members of the staffs of those organizations.
Important research and writing contributions were made by Molly Hicks of Keene Mill Consulting, LLC. Karen Boyd, a Christine Mirzayan Science and Technology Fellow of the National Academies, and two student interns, Carla Bezold and Neesha Desai, developed background papers. Also, our thanks to Rona Briere, who edited the reports, and to Alisa Decatur, who prepared them for publication.
OCR for page R21
Hospital-Based Emergency Care: At the Breaking Point
Contents
SUMMARY
1
Study Charge,
1
The Challenge of High Demand and Inadequate System Capacity,
2
Findings and Recommendations,
4
Achieving the Vision of a 21st-Century Emergency Care System,
12
1
INTRODUCTION
17
A Growing National Crisis,
19
Impact on Quality and Patient Safety,
23
Purpose of This Study,
27
Study Scope,
29
Study Approach,
30
A Note about Terminology,
31
Organization of the Report,
32
2
THE EVOLVING ROLE OF HOSPITAL-BASED EMERGENCY CARE
37
Imbalance between Demand and Capacity,
38
The Emergency Department as a Core Component of Community Ambulatory Care,
42
Reimbursement for Emergency and Trauma Care,
52
Challenges of Care for Mental Health Conditions and Substance Abuse,
59
Rural Emergency Care,
65
Summary of Recommendations,
70
OCR for page R22
Hospital-Based Emergency Care: At the Breaking Point
3
BUILDING A 21ST-CENTURY EMERGENCY CARE SYSTEM
81
The Goal of Coordination,
82
The Goal of Regionalization,
87
The Goal of Accountability,
94
Current Approaches,
102
A Proposal for Federal, State, and Local Collaboration through Demonstration Projects,
107
Need for System Integration and a Federal Lead Agency,
110
Summary of Recommendations,
124
4
IMPROVING THE EFFICIENCY OF HOSPITAL-BASED EMERGENCY CARE
129
The ED in the Context of the Health Care Delivery System,
129
Understanding Patient Flow through the Hospital System,
131
Impediments to Efficient Patient Flow in the ED,
135
Strategies for Optimizing Efficiency,
139
Overcoming Barriers to Enhanced Efficiency,
152
Summary of Recommendations,
160
5
TECHNOLOGY AND COMMUNICATIONS
165
Information Technology in the Health Care Delivery System,
167
Information Technology in the Emergency Department,
171
New Clinical Technologies,
190
Barriers to the Adoption of Information Technology,
194
Prioritizing Investments in Emergency Care Information Technology,
200
Summary of Recommendations,
202
6
THE EMERGENCY CARE WORKFORCE
209
Physicians,
210
Nurses and Other Critical Providers,
229
Enhancing the Supply of Emergency Care Providers,
236
Building Core Competencies,
238
Addressing the Issue of Provider Safety,
240
Increasing Interprofessional Collaboration,
243
Addressing the Shortage of Rural Emergency Care Providers,
247
Summary of Recommendations,
251
7
DISASTER PREPAREDNESS
259
Defining Disaster,
260
Critical Hospital Roles in Disasters,
265
Challenges in Rural Areas,
281
Federal Funding for Hospital Preparedness,
283
OCR for page R23
Hospital-Based Emergency Care: At the Breaking Point
Summary of Recommendations,
285
8
ENHANCING THE EMERGENCY CARE RESEARCH BASE
291
Emergency Medicine Research,
293
Trauma and Injury Control Research,
304
Barriers to Emergency Care Research,
311
Summary of Recommendations,
315
APPENDIXES
A
Committee and Subcommittee Membership
321
B
Biographical Information for Main Committee and Hospital-Based Emergency Care Subcommittee
323
C
List of Presentations to the Committee
337
D
List of Commissioned Papers
343
E
Statistics on Emergency and Trauma Care Utilization
345
F
Historical Development of Hospital-Based Emergency and Trauma Care
353
G
Recommendations and Responsible Entities from the Future of Emergency Care Series
365
INDEX
383
OCR for page R24
Hospital-Based Emergency Care: At the Breaking Point
This page intentionally left blank.
OCR for page R25
Hospital-Based Emergency Care: At the Breaking Point
HOSPITAL-BASED EMERGENCY CARE
OCR for page R26
Hospital-Based Emergency Care: At the Breaking Point
This page intentionally left blank.
