The U.S. healthcare network for acute unscheduled care (government lingo for “I need to see a doctor now”) has become increasingly complex. While policymakers stress the importance of patient-centered medical homes and primary care access, patients frequently choose the accessibility, expediency, and comprehensive services of the emergency department.
EDs are the hub for medical issues that come up suddenly; always open, they provide 30 percent of the nation’s acute-care visits and more than two-thirds of all care for the uninsured. However, there are important repercussions for patient safety, care quality, and service satisfaction when these sudden medical encounters are provided in a fragmented care model with unreliable transitions back to a medical home. Patient-centered solutions to these challenges are rare; unfortunately, return visits to the ED are not.
When patients do re-visit the ED, Rising et al found patients are “anxious about symptoms, unsure of what else to do, and have lost trust in the healthcare system’s interest in serving as their advocates. They see options as limited to calling a provider in the hope of a timely appointment or coming back to sit in the waiting room until they can be treated again in the ED.” (“Return Visits to the Emergency Department: The Patient Perspective,” Annals of Emergency Medicine, Vol 65, No. 4 April 2015). These authors suggest the medical community must be better at delivering care to patients “when and where they want.”
From that perspective, it is easy to understand how broadening the traditional ED visit into patient-centric, acute-care episodes can strengthen patient-physician relationships, improve reliability, and restore trust and loyalty between patient and the healthcare network.
In Dallas-Fort Worth, emergency medicine physicians have partnered with CirrusMD to launch the Safe Transitions virtual care initiative to improve post-ED patient safety and care quality, and reduce avoidable ED re-utilization. Following ED discharge, patients with continuity of care questions or concerns now have direct access back to our emergency physicians via “text-first” web and mobile app interfaces 24 hours a day, at no charge to the patient. The strategy adopts in a systematic manner the best practice of many of our physicians who provide personal phone numbers to their patients for safety and patient experience purposes.
Emergency physicians have a unique view on the frontlines of the medical care system. We understand the gaps, and are creating solutions to fill them. Emergency care has never been more important than it is right now. Re-imagining the role of these dedicated specialists through patient safety and care coordination initiatives like Safe Transitions will be essential to ensuring patients receive the right care at the right time from the right provider.
Matthew Muller, MD, practices emergency medicine in Dallas. He is a safety and quality officer at Emergency Medicine Consultants Ltd. and leads the organization’s telehealth initiatives.