Hospital-based emergency care : at the breaking point / Committee on the Future of Emergency Care in the United States Health System, Board on Health Care Services.

Format:

Book

Contributor:

Institute of Medicine (U.S.). Committee on the Future of Emergency Care in the United States Health System.

Series:

Future of emergency care

Language:

English

Subjects (All):

Hospitals--Emergency services.

Hospitals.

Emergency medical services.

Emergency Service, Hospital.

United States.

Health Care Reform.

Medical Subjects:

Emergency Service, Hospital.

United States.

Health Care Reform.

Physical Description:

xxiii, 397 pages : illustrations ; 24 cm.

Place of Publication:

Washington, D.C. : National Academies Press, [2007]

Summary:

Today our emergency care system faces an epidemic of crowded emergency departments, patients boarding in hallways waiting to be admitted, and daily ambulance diversions. Hospital-Based Emergency Care addresses the difficulty of balancing the roles of hospital-based emergency and trauma care-not simply urgent and lifesaving care, but also safety net care for uninsured patients, public health surveillance, and disaster preparation-in the face of increasing patient volume and limited resources. This book considers the multiple aspects to the emergency care system in the United States by exploring its strengths, limitations, and future challenges. The wide range of issues covered includes: The role and impact of the emergency department within the larger hospital and health care system. Patient flow and information technology. Workforce issues across multiple disciplines. Patient safety and the quality and efficiency of emergency care services. Basic, clinical, and health services research relevant to emergency care. Special challenges of emergency care in rural settings. Hospital-Based Emergency Care will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.

Contents:

Study Charge 1

The Challenge of High Demand and Inadequate System Capacity 2

Findings and Recommendations 4

Achieving the Vision of a 21st-Century Emergency Care System 12

A Growing National Crisis 19

Impact on Quality and Patient Safety 23

Study Scope 29

Study Approach 30

2 The Evolving Role of Hospital-Based Emergency Care 37

Imbalance between Demand and Capacity 38

The Emergency Department as a Core Component of Community Ambulatory Care 42

Reimbursement for Emergency and Trauma Care 52

Challenges of Care for Mental Health Conditions and Substance Abuse 59

Rural Emergency Care 65

3 Building a 21st-Century Emergency Care System 81

The Goal of Coordination 82

The Goal of Regionalization 87

The Goal of Accountability 94

Current Approaches 102

A Proposal for Federal, State, and Local Collaboration through Demonstration Projects 107

Need for System Integration and a Federal Lead Agency 110

4 Improving the Efficiency of Hospital-Based Emergency Care 129

The ED in the Context of the Health Care Delivery System 129

Understanding Patient Flow through the Hospital System 131

Impediments to Efficient Patient Flow in the ED 135

Strategies for Optimizing Efficiency 139

Overcoming Barriers to Enhanced Efficiency 152

5 Technology and Communications 165

Information Technology in the Health Care Delivery System 167

Information Technology in the Emergency Department 171

New Clinical Technologies 190

Barriers to the Adoption of Information Technology 194

Prioritizing Investments in Emergency Care Information Technology 200

6 The Emergency Care Workforce 209

Physicians 210

Nurses and Other Critical Providers 229

Enhancing the Supply of Emergency Care Providers 236

Building Core Competencies 238

Addressing the Issue of Provider Safety 240

Increasing Interprofessional Collaboration 243

Addressing the Shortage of Rural Emergency Care Providers 247

7 Disaster Preparedness 259

Defining Disaster 260

Critical Hospital Roles in Disasters 265

Challenges in Rural Areas 281

Federal Funding for Hospital Preparedness 283

8 Enhancing the Emergency Care Research Base 291

Emergency Medicine Research 293

Trauma and Injury Control Research 304

Barriers to Emergency Care Research 311

A Committee and Subcommittee Membership 321

B Biographical Information for Main Committee and Hospital-Based Emergency Care Subcommittee 323

C List of Presentations to the Committee 337

D List of Commissioned Papers 343

E Statistics on Emergency and Trauma Care Utilization 345

F Historical Development of Hospital-Based Emergency and Trauma Care 353

G Recommendations and Responsible Entities from the Future of Emergency Care Series 365.

Notes:

Includes bibliographical references and index.

ISBN:

0309101735

9780309101738

OCLC:

77716564