As a subscriber, I respect Modern Healthcare greatly. It consistently offers insightful and current information. As someone who has worked in the emergency medicine industry for many years, I'd like to offer a different perspective to your publication's portrayal of emergency care than the one presented on the July 28 Data Points page.
Emergency care statistics don't tell the whole story, and other letters
Regarding the “23% increase in ED visits between 2000 and 2010,” certainly there has been a well-documented increase in ED visits. However, there are numerous and complex reasons for the increase, not the least of which is the primary-care shortage. Also, it is risky to simply link cost with ED visit volume.
About “Time taken in the ED for 25% of patients—less than 15 minutes.” A very valid reason for this is because emergency physicians are known as “master diagnosticians.” Perhaps this is truly an indication of the efficiency of our EDs.
About the “$9.2 billion for falls, motor vehicle accidents and poisoning,” I know of no better place than an ED to go for any of these patient scenarios.
Finally, the “13.3% of ED visits resulting in hospital admissions” misses the point that upward of 75% of all hospital admissions come via the ED. These physicians really do see and treat the most severely ill and injured patients. Emergency departments are not the cause of our healthcare system's problems. Many call our EDs the “safety net” of the system; in many ways our EDs are the only net of the system.
John G. HolsteinDirectorZotec PartnersBala Cynwyd, Pa
Regarding the story “Robin Williams' death a wake-up call for mental health workers,” the complexity of mental illness is immensely more taxing on everyone involved than treating any other type of illness, in my opinion. I've been a nurse for 30 years and have seen all types of mixtures of illnesses. Family and friends can be helpful to the therapist and psychiatrist in determining the family burden for caregivers dealing with the patient. They also can give insight into specific family members or entire family cultures that can be contributing to the emotional suffering of the patient.
Patients who are mentally ill are vulnerable in two ways: They can need help so desperately, but the laws don't provide enough leeway to help a patient get to a place for clearer thinking and physical attention. (Often, these patients are dehydrated, malnourished, and personal hygiene has been omitted from any regimen, as has sleep and feeling safe.) Then, if they have self-medicated, one is never sure as to what and how much or how long they've been on or off their medications. Intense involvement is necessary by the treatment team.
Lisa NabholzConway, Ark.
Regarding “Better ED efficiency a win-win in changing healthcare environment,” better communication is always a good thing, but these performance improvements are hardly innovative. What is innovative is making sure that emergency department patients require emergent care, and if not, to provide them with real-time alternatives. For that to happen, Emergency Medical Treatment and Labor Act medical screening must happen before the patient crosses the ED threshold.
If the patient doesn't require emergent care, innovative organizations are able to redirect patients to more appropriate venues on their campus, in hospital-owned practices or community clinics. The ED must be reserved for emergent patients. Using high-cost ED services for care more appropriately delivered by a primary-care physician does not make good clinical or business sense.
Stefani DanielsManaging partnerPhoenix Medical ManagementPompano Beach, Fla.
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Regarding the recent story “Patients' cost sensitivity worries some doctors,”consumers price-shop for cars, appliances and houses. That physicians and other clinicians freak out when they're asked about price information is so short-sighted.
I've been telling my audience for years to ask “how much is that?” whenever they're making healthcare purchases. Part of shared decisionmaking—and patient-centered medicine—means putting people commonly called patients in the way of all the information they need to make a decision that meets their values and desired outcomes.
Casey QuinlanMighty Casey MediaRichmond, Va.
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