Arthur Kellermann, workshop chair and an original member of the 2006 Institute of Medicine (IOM) Committee on the Future of Emergency Care in the U.S. Health Care System, opened the workshop with a welcome and introduction.
He noted that the workshop had succeeded in attracting many of the top minds in the emergency and trauma care community from around the country. He reminded them that they had come to Washington, DC, at a time of heated debate about health care reform and that the outcome of that debate could determine the future shape and configuration of the American health care system. He observed that a number of representatives from the federal government were in attendance and would be participating in the discussions. He said that the workshop discussions could “immediately and directly influence the efforts of the federal government and state governments as they engage and promote regionalization.”
Kellermann informed the attendees that “our task, and our opportunity, is to define regionalization more clearly, detail how it might be advanced, discuss what some of its potentials and pitfalls are, and determine whether it might improve the health and wellbeing of our fellow citizens.”
He said that the three IOM reports released in 2006 received substantial attention at the time, and continue to be discussed on Capitol Hill and elsewhere. He noted that the reports have had a real impact on decision making, policies, and organizational strategies throughout the U.S. government.
The 2006 IOM committee, Kellermann reminded attendees, had four goals: (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 concrete, actionable strategies for realizing that vision.
The 2006 committee identified many challenges and problems with the existing system:
Emergency department crowding and frequent EMS diversions.
Fragmentation of care—not only geographically, but across disciplines, in the continuum of care, and within levels and agencies of state and federal government.
Inadequate disaster preparedness.
Deficiencies in the care of children.
An inadequate base of emergency care research.
Serious challenges to emergency care financing, including the liability environment, and workforce issues that threaten the long-term viability of our nation’s emergency and trauma care system.
The 2006 IOM committee offered a number of concrete, actionable recommendations (see Appendix C). Kellermann highlighted five:
Establish a lead federal agency in the Department of Health and Human Services that would ultimately be accountable for promoting and advancing emergency care.
Promote strategies to advance and strengthen pediatric emergency care, not only in pediatric hospitals, but across the U.S. health system, both in prehospital settings and through hospital-based emergency care.
Improve the organization and funding of emergency care research.
End the practices of boarding and EMS diversion.
Regionalize the delivery of emergency and trauma care throughout the country, drawing on past successes with trauma care systems but extending the concept in other dimensions.
“The committee’s vision, then and now, was of a ‘regionalized, coordinated, and accountable emergency care system’” Kellermann said. “Our task is to flesh out what this concept means and how it can be actualized at the state and local level, within geographic regions, and across the nation. The attendees at this conference have the opportunity to help inform and advise the federal government as they set out to achieve this vision.”
A number of questions remain, Kellermann pointed out. “What does regionalization entail? Is it simply transporting patients to higher-level hospital facilities? Is it diffusing knowledge throughout a region? Is it identifying specific institutions with the expertise to handle specific patient problems? Is it always about the most severely ill or injured? How does
regionalization work during a large disaster or mass-casualty event? Is it different in rural areas than in urban or large metropolitan areas?” He said that over the next 2 days attendees would cover any number of permutations and manifestations of the regionalization concept.
Kellermann reminded attendees that an IOM workshop is quite different than an IOM consensus committee. “There will be no showing of hands” he said, “and it will not produce a consensus statement at the end of the meeting. IOM workshops are designed to promote free-wheeling discussion and to facilitate an open exchange of ideas.” The final product, the workshop summary, will provide a compilation of divergent opinions exploring the topic, not an explicit set of new recommendations.
He noted that the participants may feel a tendency at times to advocate for their particular discipline or specialty or hospital system’s interests. He said, “Please try not to do that. You are not here to defend turf. You are here to help us advance the issues, the cause, and the field. Each of you was purposefully sought out and recruited for your expertise and your knowledge. You are not here to serve as an advocate. You are here to serve as experts.” With that overview and challenge, the workshop sessions began.