Regionalization

The unified system supports the regional emergency and trauma system through clinical operating guidelines that determine the care and transport of all emergency and trauma patients. But the system is focused more on coordination and medical direction of EMS than on regionalization of care.

Accountability

A Healthcare Quality Committee is charged with reviewing the performance of the system and recommending specific actions to improve quality.

Palm Beach County, Florida

An initiative currently under way in Palm Beach County, Florida, is more limited in scope than the Maryland and Austin systems. The goal of the initiative is to find regional solutions to the limited availability of physician specialists who provide on-call emergency care services. In spring 2004, physician leaders, hospital executives, and public health officials formed the Emergency Department Management Group to address this problem. The initiative is in the early stages of development, and approaches are evolving. One approach is to attack the rising cost of malpractice insurance for emergency care providers, which discourages specialists from serving on on-call panels. The organization is developing a group captive insurance company to offer liability coverage for physicians providing care in county EDs.

Coordination

The Emergency Department Management Group is developing a web-based, electronic ED call schedule so the EMS system can track which specialists are available at all hospitals throughout the county. This will enable the system to direct transport to the most appropriate facility based on a patient’s type of injury or illness.

Regionalization

The Emergency Department Management Group is exploring the regionalization of certain high-demand specialties, such as hand surgery and neurosurgery, so that the high costs of maintaining full on-call coverage can be concentrated in a few high-volume hospitals, where the volume of cases makes it feasible to maintain such coverage. Hospitals throughout the county would pay a “subscription fee” to support the cost of on-call



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