Ricardo Martinez

Creating Integrated Networks Of Emergency Care: From Vision To Value

Emergency care is an essential component of the care delivery system in the United States, but it received little attention during the debates about health care reform. As a result, US emergency care remains outdated and fragmented. We provide an overview of efforts to regionalize emergency care in the United States, and we both identify challenges to change and recommend next steps in five domains: people, quality and processes, technology, finances, and jurisdictional politics. We offer a commonsense approach to increasing the value of emergency care delivery by developing regionalized integrated networks of emergency care that take advantage of emerging changes in the health system and are designed to meet time-sensitive patient needs.

Looking back ahead.

Last year, I had to take my second 10-year recertification examination. Being an emergency physician has always been one of the things I’m most proud of. Recertification made me fearful. Because of professional choices I had made, I had not provided direct patient care for more than 6 years. I work with emergency physicians and practice issues around the country. But more than just study for the certification examination, I wanted to regain the passion and camaraderie of practicing emergency medicine at the bedside. A few years ago, I rejoined the emergency medicine faculty at Emory University and Grady Memorial Hospital and settled down into clinical practice. Preparing for American Board of Emergency Medicine (ABEM) examination was a chance to fully reengage in my specialty and to observe changes throughout the past decade. Reentering the clinical practice world was like stepping through time. Each shift continues to provide insights, but within hours of entering today’s emergency departments (EDs), one quickly notices significant changes from just 10 to 15 years ago. As we celebrate ACEP’s 40th anniversary, it is worthwhile to share these observations. Some are changes in the health care landscape, some are specific to emergency medicine practice, and some involve changes to emergency physicians themselves. When I entered government service in the 1990s, overseeing the National Highway Traffic Safety Administration (NHTSA), emergency medicine was not well defined in the public eye. During the vetting process for my confirmation hearing, congressmen would ask me whether I was a surgeon or an internist just working in the ED. Others asked when I would complete my training and become a rightful member of the health care system. Now, people better understand and appreciate the specialty. Emergency care is clearly more stressful than before, and this is not simply a product of years away. Time pressures have always been present, but today’s demands are now excessive. The ED has been transformed from a place that admitted patients to the hospital so that they could be evaluated to a place to evaluate patients to see whether they can be admitted. The expansion of diagnostic and therapeutic options requires diagnoses to be specific. As an example, myocardial infarction must be quickly divided into types (ST-segment elevation myocardial infarction [STEMI] versus non-STEMI), location,