Volume 1 / Issue 1Fall 2006 |
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2007 Workshops February San Francisco, CA March Albuquerque, NM April Charlotte, NC May St. Louis, MO June Washington, D.C. (Exact dates to be determined) For more details on upcoming workshops, call toll-free (866) 369-8029 or see the Triage First website at www.triagefirst.com. Triage First, Inc. Phone: (828) 628-8029 Email: info@triagefirst.com www.triagefirst.com |
Literature & Research The Future of Emergency Care in the U.S. (Institute of Medicine press release) Despite the lifesaving feats performed every day by emergency departments and ambulance services, the nation's emergency medical system as a whole is overburdened, underfunded, and highly fragmented, says this series of three reports from the Institute of Medicine. As a result, ambulances are turned away from emergency departments once every minute on average and patients in many areas may wait hours or even days for a hospital bed. Moreover, the system is ill-prepared to handle surges from disasters such as hurricanes, terrorist attacks, or disease outbreaks. The Institute of Medicine's Committee on the Future of Emergency Care in the United States Health System was convened in 2003 to examine the state of emergency care in the U.S., to create a vision for the future of emergency care, including trauma care, and to make recommendations to help the nation achieve that vision. Their findings and recommendations are presented in three reports: 1. Hospital-Based Emergency Care: At the Breaking Point explores the changing role of the hospital emergency department and describes the national epidemic of overcrowded emergency departments and trauma centers. The wide range of issues covered in this report includes:
2. Emergency Medical Services at the Crossroads describes the development of EMS systems over the last forty years and the fragmented system that exists today. By addressing the strengths, limitations, and future challenges of EMS, this report, Emergency Medical Services at the Crossroads, draws upon a range of concerns:
3. Emergency Care for Children: Growing Pains describes the unique challenges of emergency care for children. This report, Emergency Care for Children, offers an analysis of:
A series of workshops will be held across the U.S. to disseminate findings from the emergency care reports and engage the public and stakeholder groups in a discussion of issues identified. For more information, see www.iom.edu and www.ena.org. The ENA website provided the following links to access free read-only versions of each of the three IOM Reports on the future of emergency care: Hospital-Based Emergency Care: At the Breaking Point Emergency Medical Services: At the Crossroads Emergency Care for Children: Growing Pains 
Literature & Research NHAMCS 2004 Emergency Dept. Summary Report Tracking and analyzing data from hospital-based emergency departments in the United States is a daunting task. Since 1992, the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics has taken on that task and compiled its findings in the National Hospital Ambulatory Medical Care Survey (NHAMCS) Emergency Department Summary. This report is published on a yearly basis and reflects the most up-to-date information available about trends in emergency department visits and patient and hospital characteristics. For comparison purposes, the report also includes trend statistics from the previous ten years. On June 23, 2006, the National Hospital Ambulatory Medical Care Survey: 2004 Emergency Department Summary was released. This report contains a wealth of information; however, for the purposes of this summary, we will look at just a few categories of interest.  Triage Acuity Levels
The report uses four different triage levels to rank the immediacy in which patients should be seen: emergent, urgent, semiurgent, and nonurgent (as well as a category of no triage or unknown). However, other than a time objective, no qualifying criteria are provided to determine how patients were assigned these different acuity levels. According to the 2004 report, the triage acuity levels of emergency patients in America broke down as follows: It is interesting to note that when the report addresses waiting and treatment times in emergency departments, however, the number of acuity levels changes from four to five: immediate, emergent, urgent, semiurgent, and nonurgent. This not only creates confusion, but validates the need for standardization of acuity scales in the United States. Without such standardization, the reader is left to question the significance of the above data. For example, the statistic showing that 13% of patients seen in U.S. emergency departments are given an emergent acuity level is limited in value and open to interpretation because of the various acuity scales used.  Method of Arrival
Other Key Statistics Abdominal pain remains the most common illness-related reason for visiting the emergency department at 6.8% of patients seen. 6% of patient visits were for follow-up of an earlier treated problem and 2.9% of patients returned within 72 hours of a prior visit. 15.1% of patients present to the emergency department with self-described severe pain and 23.7% described their pain as moderate. 78.4% of emergency department patients either received medication, had medications prescribed, or had medications continued. The two most common medication classes utilized were narcotics and NSAIDS. Emergency department visits increased from 1994 to 2004 by 18% (93.4 million visits to 110.2 million visits) while the total number of hospital-based emergency departments decreased by 12.4% for that same time frame. The Nation Hospital Ambulatory Care Survey: 2004 Emergency Department Summary can be accessed online at http://www.cdc.gov/nchs/data/ad/ad372.pdf.
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