prevalence and outbreaks and other health risks. Hospital EDs can recognize the diagnostic clues that may indicate an unusual infectious disease outbreak so that public health authorities can respond quickly (GAO, 2003). However, a solid partnership must first be in place—one that allows for easy communication of information between emergency providers and public health officials.

Importance of Linkages with Other Medical Care Providers

According to the American College of Emergency Physicians (ACEP), EDs “define their mission in terms of unlimited access regardless of citizenship, insurance status, ability to pay, day of week, or time of day…it is the only source of care available for certain populations” (O’Brien, 1999, p.19). Indeed, EDs fill many existing gaps within the health care network, serving as key safety net providers in many communities (Lewin and Altman, 2000). Studies have shown that a significant number of patients use the ED for nonurgent purposes because of financial barriers, lack of access to clinics after hours, transportation barriers, convenience, and lack of a usual source of care (Grumbach et al., 1993; Young et al., 1996; Peterson et al., 1998; Koziol-McLain et al., 2000; Cunningham and May, 2003). There is also evidence that clinics and physicians are increasingly using EDs as an adjunct to their practice, referring patients to the ED for a variety of reasons, such as their own convenience after regular hours, reluctance to take on a complicated case, the need for diagnostic tests they cannot perform in the office, and liability concerns (Berenson et al., 2003; Studdert et al., 2005). Unfortunately, in many communities there is little interaction between emergency care services and community safety net providers—this even though they share a common base of patients, and their actions may affect one another substantially. The absence of coordination represents missed opportunities for enhanced access; improved diagnosis, patient follow-up, and compliance; and enhanced quality of care and patient satisfaction.

Previous Calls for Improved Coordination

The value of integrating and coordinating emergency care has long been recognized. The 1966 National Academy of Sciences/National Research Council (NAS/NRC) report Accidental Death and Disability: The Neglected Disease of Modern Society called for better coordination of emergency care through Community Councils on Emergency Medical Services, which would bring together physicians, medical facilities, EMS, public health, and others “to procure equipment, construct facilities and ensure optimal emergency care on a day to day basis as well as in disaster or national



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