Future of Emergency Care Dissemination Workshop Summaries (2007) / Chapter Skim
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4 Workshop in Chicago, Illinois
4 Workshop in Chicago, Illinois
Pages 35-59
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From page 35... ...
He discussed the complexities of the emergency medical services (EMS) system in Illinois, noting that the state has 11 EMS systems and as many as 60 EMS medical directors.
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From page 36... ...
Eastman, chief medical officer of ScrippsHealth. Respondents included Leslee Stein-Spencer, former chief of EMS for Illinois and current policy advisor for the National Association of State EMS Officials; Bill Jermyn, EMS medical director for the state of Missouri; Stephen Hargarten, chair of emergency medicine at the Medical College of Wisconsin and director of the Injury Research Center; Thomas Esposito, trauma surgeon from Loyola University Medical Center; and Peter Butler, executive vice president and chief operating officer at Rush University Medical Center.
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From page 37... ...
He added that we should learn from leaders in pediatric emergency medicine, who have appropriately positioned the concerns of children with regard to emergency care, and develop a similar focus for geriatric care. In addition, Dr.
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From page 38... ...
Another top area for action is to address the workforce shortages in order to improve surge capacity. Disaster preparedness plans often call for the creation of alternative health care facilities, but they fail to consider the fact that the workforce is often too limited to staff even traditional health care facilities.
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From page 39... ...
Sonny Saggar, president of the U.S. Alliance of Emergency Medicine, raised a similar question about how to convey the messages from the IOM reports to the public and Congress in language they will understand.
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Dr. Camilla Sasson from the Emergency Medicine Residents' Association explained that the association developed a task force to review the IOM reports.
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The liability problem in particular serves as a disincentive to continue practice, especially when some emergency medicine physicians can work in the information technology field, for example, for twice the salary with fewer work hours. Paula Willoughby DeJesus, EMS medical director for the Chicago Fire Department and from the American College of Osteopathic Emergency Physicians, cautioned that plans for regionalization of emergency care services must be practical.
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Hargarten's earlier comment that emergency care stakeholders should focus on advocating for translational research support from NIH. Instead, he said there is a need for an independent institute for emergency medicine research at NIH.
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The latest technologies will make little difference if EMS personnel cannot unload patients at EDs because of overcrowding. Chief Trotter said that stakeholders have not approached him about emphasizing emergency medical services in funding requests to DHS.
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The original proposal generated considerable controversy because it called for the acute care surgeon to perform some selected neurosurgery and orthopedic surgery in the emergency care setting to improve patient access. Concerns were raised because of the limited training time acute care surgeons would have in those areas and that patient care would be compromised.
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From page 45... ...
Dr. Krug highlighted several short-term solutions contained in the IOM reports, including having all health care certification bodies define emergency care competencies and require practitioners to receive the education and training needed to achieve those competencies; having EMS agencies and hospitals appoint pediatric emergency care coordinators to provide pediatric leadership for the organization; developing categorization systems for EMS, EDs, and trauma centers based on service capabilities; and linking rural hospitals with academic medical centers to enhance opportunities for consultation, telemedicine, patient referral and transport, and continuing education.
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Dr. Krug concluded by describing some of the activities at Children's Memorial Hospital to build and maintain providers' critical skills in emergency medical services.
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Workforce Competencies Patricia Kunz Howard, the staff development specialist/nurse researcher for the ED at the University of Kentucky Hospital and EMS training coordinator for the Lexington Division of Fire and EMS, focused her remarks on provider competencies, emphasizing the importance of collaboration. Because work in the emergency care environment is not conducted in isolation, competency solutions must be collaborative.
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From page 48... ...
The EMS Workforce Ronald Pirrallo, professor of emergency medicine at the Medical College of Wisconsin and the Milwaukee County EMS medical director, began his presentation by stating that the IOM committee's recommendations with regard to the EMS workforce are among the most clear and achievable recommendations in the reports. Over the past 40 years, there have been a number of reports that generated thoughtful, consistent recommendations on education, including Accidental Death and Disability (1966)
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From page 49... ...
According to the IOM report, Emergency Medical Services at the Crossroads, "Educational program accreditation and national certification need to be in place before the transition from the national standard curriculum to the national EMS education standards can take place." In other words, states must accept national certification and program accreditation before national standards can be implemented. The National Association of State EMS Officials has endorsed the EMS Education Agenda, with the condition that no definitive timetable would be set for implementation.
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From page 50... ...
Many emergency medicine residents would like to receive critical care certification, but the internal medicine critical care fellowship slots are closed to emergency medicine residents. Scott Altman, an emergency physician practicing in Chicago, added that, with the shortage of practitioners expected in the future, there is a need to think about new ways to distribute human resources by separating technical and cognitive personnel.
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From page 51... ...
The session was moderated by IOM committee member Brent Asplin. Response from the Joint Commission on Accreditation of Healthcare Organizations Peter Angood, vice president and chief patient safety officer at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
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From page 52... ...
Finnell, director of the Informatics Division in Emergency Medicine at Wishard Memorial Hospital, discussed two initiatives under way in Indiana to improve the efficiency of care through information technology. In most areas of the country, the health care system fragments patient information and creates redundant, inefficient efforts.
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From page 53... ...
Improving Patient Flow Linda Kosnik, chief nursing officer at Overlook Hospital, spoke about demand to capacity management, particularly with regard to surge capacity for overcrowding and disaster planning. Increased resources are often necessary to address these issues, but often simply moving the right resources to the right place at the right time will be of great benefit.
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From page 54... ...
The demand issues must be addressed. Addressing patient demand will require coordination with other components of the system, including long-term care facilities, federally qualified health centers, primary care physicians, and others.
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A second assumption made in the IOM reports is that it is the role of the hospital chief executive officer (CEO) to address efficiency.
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Dr. Nedza added that the systems that have been best able to address the problems described in the IOM reports
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He began his presentation by describing the research showing that trauma centers and trauma systems save lives. Between 1992 and 2002, Canada implemented a coordinated, regionalized, accountable system of trauma care that resulted in a dramatic decline in the mortality rate per population per vehicle mile driven.
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Fifth, regionalization does not mean centralization. Regionalization does not mean that one hospital is responsible for all trauma care or all emergency care.
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From page 59... ...
He emphasized the need to create a simple, concise, and consistent message about emergency and trauma care that all stakeholders can convey to policy makers. CLOSING To close the meeting, Dr.
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