AT BOSTON HOSPITALS, demand for the emergency department often exceeds capacity, resulting in longer wait times and overcrowding. Other emergency departments around the nation are also experiencing similar scenarios—and the problem is magnified in essential health systems that deliver care for underserved populations from historically marginalized communities.
This national crisis must serve as the catalyst to bring long overdue transformational change to emergency care – a change that will improve the overall health and wellbeing of communities.
Last month, Boston Medical Center convened a coalition of national emergency department leaders for the second straight year to recommend solutions to strengthen existing care models and develop achievable solutions that will help patients thrive beyond emergency care. The Strengthening Essential Emergency Departments conference brought together 16 major health systems that specialize in caring for underserved populations around the country—including Denver Health Medical Center, University of Alabama Birmingham Hospital, Zuckerberg San Francisco General, and University of Washington Medical Center – to reimagine and advance emergency care medicine.
We envision a future where emergency care is designed to meet the needs of all patients, including those who face chronic health conditions stemming from generations of systemic racism and disinvestment in their communities. Emergency department staff must be trained and supported to identify and address the social determinants of health that directly impact so many of our patients, from food and housing insecurity to lack of opportunities for jobs and education.
Emergency services also must be financially sustainable for health systems and patients. Value based care – where best in class healthcare is delivered through new models of care that treat patients’ needs holistically and with maximum efficiency — will be critical to a new path forward.
While we look to the future of emergency care, there are structural and funding issues that must be addressed today to ease the current capacity crisis in our nation’s emergency departments.
Healthcare organizations across the country are still grappling with staffing issues, following retirements and resignations since the COVID pandemic. At the same time, volume continues to increase, as we see a higher level of sicker patients. Many patients also come to the emergency department for routine health concerns because of a lack of access to primary care.
The shortage of post-acute rehabilitation beds for patients who are ready for discharge is also a major strain on emergency departments across the country. We are often unable to discharge inpatients for lack of a bed in a rehabilitation facility, leaving newly arrived patients to wait for hours or even days in emergency departments until an inpatient bed opens up.
For many emergency departments, all of these issues come together to create a perfect storm. This clogs waiting rooms, causes stress for staff, and forces patients with true emergencies to wait longer.
The good news is this crisis has already inspired solutions in essential emergency departments. For example, BMC has implemented cutting-edge initiatives to reduce wait times in the emergency department. BMC’s newly developed Rapid Assessment Zone begins with a nurse who rapidly screens patients, followed by a multi-disciplinary clinical team that examines patients together and is focused on efficient and timely care. This adds value to the patient care experience.
Beyond such efforts at the health system level, the Strengthening Essential Emergency Departments coalition is calling for increased funding and support to meet these complex challenges. Federal legislation led by Congresswoman Lori Trahan of Massachusetts and supported by America’s Essential Hospitals could be a step in the right direction, creating a federal safety-net hospital designation. If passed, this could serve as a vehicle to provide targeted funding to support the unique needs of emergency care in essential hospitals.
There is much work ahead of us if we truly want to bring transformational change to emergency care in our country. As the front door to the healthcare system – one that cares for people when they need help the most – change is urgently needed. But it can’t happen without a broad-based commitment from all stakeholders, one that puts patient and community voices at the center of innovation.
Dr. Christian Arbelaez is the chief of the department of emergency medicine at Boston Medical Center.
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