The Emergency Department (ED) is where people turn in their time of need. It is open 24 hours a day, 7 days a week, 365 days a year. The department is the people’s safety net— and it’s a big net. The Emergency Department handles crises ranging from physical, emotional and social problems and helps people no matter their background, status or condition.
Emergency Medicine (EM) is a “street-facing career,” says Emory ED Resident Physician Dr. Megan Davis, where “no patient is ever turned away, [and]you function as a physician, friend, social worker and counselor.”
The extensive importance and function of the ED requires that the profession be continuously and ferociously protected and progressed, by driving technological advances and engaging in research that impacts health locally, nationally and globally.
Today, EM primarily offers a brick-and-mortar-based care system: Patients arrive at the ED, are triaged based on priority of condition and then wait to be seen. An evaluation and treatment plan are developed, and the patient is dispositioned to “admit,” “home,” or “observation.” In this current system, the ED endures high volumes, long waits and frustration for both the patients and providers. By incorporating technology, care can be untethered from the brick-and-mortar system and be delivered at home, at work, or on the go with more equitable and omni-channel access.
EM-trained physicians are driving this innovation through leadership roles in digital health and health technology. Dr. Ricardo Martinez, a physician executive and 10th Administrator of the National Highway Traffic Safety Administration, notes that the biggest trends in emergency medicine are expanded access to care by patients through technology in the communities that health systems serve, and expanding the reach of emergency medical evaluation and care by ‘going to the patient.’
“Emergency medicine will continue to evolve rapidly to meet the patient’s needs by meeting them where they are,” Dr. Martinez says. “With these time-sensitive conditions, creating rapid access between emergency physicians and patients is critical.”
Emory University Department of Medicine’s Health DesignED, led by inaugural Executive Director Dr. Monique Smith, is an Emory ED innovative center dedicated to redesigning how patients interface with the healthcare system. This design center aims to create a more seamless, equitable and holistic experience for patients — and it starts at the moment a person experiences a symptom. This first part of the design is pre-triage or “priage,” and this begins a person’s journey in the healthcare system by navigating their first step virtually.
A person answers a few basic questions online,then is directed to virtual care, emergency care, urgent care or primary care. With the structures created by the Health DesignED, a person can be connected directly to a doctor for guidance. These doctors are known as “virtualists” and are led by Dr. Mike Ross, director of virtual EM services at Emory.
“Increasingly, core members of the emergency care teams will be trained as virtualists, specializing in telemedicine, virtual care and remote patient monitoring, unleashing the potential for care anywhere and care everywhere,” says Dr. Kate Heilpern, former chair of emergency medicine at Emory and former SAEM president, about this emerging and promising method of care.
Within the ED, technology can both improve a patient’s experience and outcomes.“Wearable technology and artificial intelligence programs will increasingly assimilate individual patient information and help guide care,” Dr. Heilpern says. “This is important for the diagnosis and treatment of each person seeking care, but it won’t stop there. Using big data, pattern recognition of patients’ signs and symptoms will be analyzed and contextualized with local and regional public health concerns. This will be game changing for the early warning of infectious disease outbreaks, climate change events and local disasters. And, this means faster tailored care for people and communities at risk.”
The last piece of the Health DesignED is “after-care,” of which technology is essential. With tech-enabled access points, a holistic care continuum is created, allowing support for patients through every step of their health journey. This is only possible with technology.
e, When it comes to integration of technology, “the core mission of EM – to provide expert lifesaving care to whomever needs it, 24/7/365, will not change,” says Dr. Arthur Kellermann, former Chair of Emory Emergency Medicine, a former fellow of the American College of Emergency Physicians and an elected member of the U.S. National Academy of Sciences in the Institute of Medicine. “AI may help one day by suggesting a rare but relevant diagnosis, but it cannot secure an airway, comfort a panic-stricken child, or stop life-threatening bleeding.”
What is going to change, Dr. Kellermann says, is how “the EM team will be increasingly tasked with preventing as many admissions as possible through skillful use of advanced diagnostics, precise use of clinical decision units and initiation of hospital-at-home care for all but the sickest and most severely injured patients.
“What it must stop being,” he adds, “is the one place in our healthcare system that handles any and every problem no one else wants to do, whether it is care of the homeless, the de-institutionalized mentally ill, or tens of millions of Americans who lack basic access to primary care.”
During the COVID-19 pandemic, people were forced to rely on technology to communicate. From this, teleworking emerged and is now widely used and often preferred despite being in a “post-pandemic” era.
“The silver lining from the COVID-19 pandemic was that the global crisis accelerated the ingenuity and creativity of the delivery of urgent and emergent care,” Heilpern says. “The fortitude and adaptability of emergency medicine providers combined with revolutionary advances in technology are leading to breakthroughs in how, when and where emergency care is delivered, and this is just the beginning.”
In 2020, when the COVID-19 pandemic hit, the Emergency Department became the front line against the virus and continues to be the front line to any and all dangers of the world. Strengthening that front line is of the utmost importance.
The recent National Resident Matching Program results left the Emergency Medicine residency programs with more than 500 open spaces. The ED was once one of the most sought-after residencies.
“Reasons for the lower numbers of interested medical students and the unfilled positions are multifactorial,” says Dr. Angela Mills, President of the Society for Academic Emergency Medicine, “and have been considered to include COVID-19 pandemic stressors with resultant burdens of unparalleled ED boarding and staffing shortages, the national crisis in acute behavioral health emergencies, increased workplace violence, burnout, the corporatization of medicine and prior EM workforce surplus projections.”
As the specialty looks toward the future, in the midst of chronic ER strain and technological revolution, there must be a focus on innovative solutions to alleviate the ED and strengthen patient care.
I am optimistic for the future of emergency medicine and excited to see where technology will guide the specialty. I will continue to direct every resource possible to help the Emory Emergency Medicine team and the profession make a difference in the lives of patients in need, the careers of students and residents, and the health of the communities and people we all dedicate to serving with compassion and equity.
Dr. Kate Heilpern is a former President of the Society for Academic Emergency Medicine, and Chief of the Office of Provider Professionalism and Support, New York-Presbyterian Hospital.
Dr. Arthur Kellermann is a fellow of the American College of Emergency Physicians and served on their board for six years. He is an elected member of the U.S. National Academy of Sciences in the Institute of Medicine.
Dr. Ricardo Martinez was the 10th Administrator of the National Highway Traffic Safety Administration, is a practicing EM physician for over 20 years, and is a Super Bowl medical consultant to the National Football League focusing on emergency services, spectator care and injury prevention.
Dr. Angela Mills is President of the Society for Academic Emergency Medicine and the J. E. Beaumont Professor and Chair at Columbia University Irving Medical Center