How will the emergency department's role in overall health care delivery change in coming years?



Dr. Jeff Collins, chief medical officer, Providence Health Care: In recent years, emergency departments have become the focal point for care in the United States, playing a variety of critical roles by providing much needed emergency medical services, in addition to serving as the primary-care safety net, a major venue for acute diagnostic and treatment, as well as a 24/7 portal for rapid inpatient admission.

Approximately one-quarter of all outpatient visits in the United States occur in emergency departments and nearly one-third of all hospital admissions are a result of emergency department encounters. In Spokane, emergency department activity has also risen in the past 10 years and is now approaching more than 135,000 annual encounters at Providence's three urban emergency care locations.

Emergency department utilization here and across the nation has increased significantly primarily because of an inadequately structured primary-care system compounded by a lack of access to affordable insurance coverage. And as a result, emergency departments have become the primary point of entry, too often offering inefficient care that could be provided in a timelier, more convenient, and less expensive setting for patients.

Beginning next year, as the Patient Protection and Affordable Care Act is rolled out nationwide, many more individuals than ever before will have access to our health care system, and that is a good thing. However, this influx will initially put great pressures on our already burdened emergency care network.

In order to stabilize the system, we believe that it will be imperative to work more closely with our community partners like Community Health Association of Spokane (CHAS) and Christ Clinic to promote better access for those typically underserved populations. At the same time, we'll develop a coordinated network of community primary-care clinics, making it easier for people to connect with a medical home, thus avoiding costly visits to the emergency department.

Another important strategy will be to create viable alternatives to typical emergency rooms, such as urgent-care centers that can cost effectively treat a wide range of common illnesses and injuries.Combining these strategies with an integrated electronic medical record system will be among the most important steps to creating a seamless and coordinated approach to care.

We believe that better primary-care access will significantly reduce the inappropriate use of the emergency department as the primary point of care. Ultimately, the goal is to provide the right care, at the right time, in the right place by creating a coordinated system that features high quality, accessible, and affordable care for everyone.



William L. Gilbert, CEO, Deaconess Hospital: As an integrated health care delivery system, we are fortunate to have strong partnerships that improve the patient's experience across the continuum of care. A primary goal of the Rockwood Health System is for the patient to get the right care, in the right place, at the right time. This requires close collaboration between primary-care physicians, emergency room teams, and others who interact with the patient.

Together as a team, we actively manage patients' health and chronic conditions, such as congestive heart failure and diabetes, to prevent unnecessary emergency department visits. We strive to keep the patient as healthy as possible, out of the hospital, and with access to care in the setting that is best for them. Our network of six urgent-care facilities provides patients with care for nonemergent conditions that may need to be treated sooner than an appointment in a physician's office becomes available.

The emergency room will always be a vital community resource and an integral part of the hospital's services. Those with true emergent conditions deserve the best care possible. That's why we've made a concerted effort to improve quality and earn designations for the care for life-threatening emergencies. At Deaconess, these include becoming a certified chest pain center, a joint commission primary stroke center, and a level III trauma center.

Quality, as well as patient-centered care, will define the emergency room in the future. We are focused on reducing the door-to-provider time and the overall visit time, while also enhancing service through rounding on patients in the waiting room and undergoing treatment, as well as phone calls to check in on the patient after discharge to identify any health concerns or service issues. Faster treatment, more efficient flow, and high quality, evidence-based care are the long-term goals for emergency care at Deaconess and within the Rockwood Health System.