National Emergency Care Enterprise: Advancing Care Through Collaboration: Workshop Summary (2009)

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Overview In 2006, the Institute of Medicine (IOM) released a series of three r ­ eports on the Future of Emergency Care in the United States Health System. These reports contained recommendations that called on the federal govern- ment and private stakeholders to initiate changes aimed at improving the emergency care system. Three years later, in May 2009, the IOM convened a workshop to examine the progress to date in achieving these objectives, and to help assess priorities for future action. One of the central recommendations of the IOM reports was that the federal government should more effectively coordinate the many emer- gency care-related activities that are now dispersed among various federal departments and agencies. Federal coordination of prehospital emergency care was already advancing through the Federal Interagency Committee on Emergency Medical Services (FICEMS). Following the release of the IOM reports, the Department of Health and Human Services (HHS) created the Emergency Care Coordination Center (ECCC) within the Office of the Assistant Secretary for Preparedness and Response (ASPR) to coordinate federal activities relating to hospital-based emergency care. Together, ECCC and FICEMS have established the “National Emergency Care Enterprise,” a collaborative construct that covers the entire spectrum of emergency care, including prehospital, in-hospital, intensive care, surgery, and posthospital placement. The formal embodiment of this collaboration is the Council of Emergency Medical Care, which promotes information exchange and joint problem solving across the various federal agencies. The May 2009 workshop was convened to bring stakeholders and policy makers together to discuss which among the many challenges facing  

 NATIONAL EMERGENCY CARE ENTERPRISE emergency care are most amenable to coordinated federal action. Its objec- tives were threefold: 1.  oster information exchange among federal officials involved in F advancing emergency care and key stakeholder groups from around the country. 2.  dentify policy areas that are of great and immediate concern to I stakeholders and federal policy makers. 3.  old discussions with federal partners regarding the policy and H programmatic areas that should be the focus of coordinated federal action. In attendance were policy makers from the various federal agencies involved in emergency care, state and local officials, and stakeholders from the health care provider community. These included thought leaders from a wide range of relevant disciplines, including nursing, emergency medical services (EMS), specialist physicians and surgeons, public health officers, and hospital and health system administrators. The 2-day workshop was structured to emphasize interactive discus- sion among panelists and participants. Rather than giving long lectures, each panelist provided a 5-minute opening statement, accompanied by a single PowerPoint slide that summarized his or her key points. Following these presentations, the session chair opened the floor for discussion. This process ensured that attendees were actively engaged throughout the 2-day workshop. It also stimulated a number of rich interactive exchanges. These are captured in the chapters that follow. Chapter 1 of this report contains the opening introduction by work- shop chair Dr. Arthur Kellermann, followed by a keynote address by Dr. Jeff Runge. These are followed by presentations from three federal o ­ fficials—­Michael Handrigan (HHS/ASPR), Drew Dawson (Department of Transportation/National Highway Traffic Safety Administration), and Dan ­Kavanaugh (HHS/Health Resources and Services Administration), who d ­ etailed the federal progress in achieving the IOM recommendations set forth in 2006. A more detailed account of each agency’s activities, address- ing each report recommendation in detail, is contained in Appendix C. Chapter 2 captures a facilitated interactive exchange among the members of the audience. These participants brought their personal insights and exper- tise to the table. The interactions that followed covered a wide range of topic areas related to emergency care. The focus of this discussion was the impact of federal policies on emergency care providers at the community level. Chapters 3–6 detail the four panel sessions. Each was focused on a criti- cal topic in emergency care. These included quality and patient safety, emer- gency care research, health professions training, and emergency care eco- 

OVERVIEW  nomics. Finally, Chapter 7 summarizes the final interactive discussion among the workshop participants and the federal partners, exploring the topic areas that the federal government should focus on most immediately. The workshop was sponsored by the ECCC, the newly formed federal lead agency within HHS, with additional support provided by the American College of Emergency Physicians and the Society for Academic Emergency Medicine. A Note on Definitions The terms “emergency medical services (EMS)” and “emergency care” are sometimes ambiguous. In this summary, EMS is used to denote pre­ hospital EMS only, although some participants quoted in the text use it to mean the broader emergency care system. Several speakers (notably the trauma surgeons) used the term “emer- gency care,” but specified that they were not referring only to emergency medicine, the specialty, but more broadly, as in trauma and emergency care. As described in the 2006 series of IOM reports, “emergency care” also includes care of patients immediately after they leave the emergency depart- ment, including trauma surgery and postoperative critical care. Participants sometimes referenced this as “the big emergency care.” Also, the terms “emergency room (ER)” and “emergency department (ED)” are often used by different people to reference the same thing. The IOM uses the term ED, but many speakers at the workshop (especially the hospital administrators) preferred the term ER, and that is reflected in the text.