A Regulator, Harvard Prof. Walk Into An ER ...

Between the health reform’s goal of avoiding acute hospitalizations, the rise of urgent care clinics and the new possibilities of digital health, emergency rooms are poised for transformation. Indeed, a much needed one.  Federal and state regulators, medical professors and experts of all sorts have a lot of ideas and initiatives aimed at preventing ER-based treatment of uncontrolled chronic conditions like diabetes and heart disease — by nipping the problems that would lead to an emergency in the first place — as well improving the ER experience for those who do need to use emergency care.

For some, the ER is a stark reminder of why “patient-centered” healthcare is now a much-heralded mantra. As recent experiences by prominent health professionals show, an ER visit can bring to mind long waits for a cable guy that may never show, lost baggage and flight delays, plus physical pain and of course a lot of money spent.  “There’s just something about being boarded on a gurney in a hospital hallway for fifteen hours that gets one thinking about paradigm shifts,” as Charlotte Yeh, MD, a trained emergency care physician and the chief medical officer for AARP Services, wrote in Health Affairs describing her ER and hospital stay after being struck by a car.

More views on ER came recently one summer evening from Niall Brennan, the Centers for Medicare & Medicaid Services’ director of information products and analytics, as he entered Johns Hopkins Medicine’s Suburban Hospital, for what would be the first of two ER visits in 36 hours.  While Brennan did not want to elaborate on his experience and it would not be appropriate to pry, his public comments do suggest that, if not Byzantine per se, the American ER is an area of healthcare with a lot of room for improvement, despite the good intentions of doctors, nurses and administrators, the investments in comprehensive electronic health records, and attempts at quality measurement.  There may not be a quality metric for time spent waiting for an empty IV line to be removed, but there are metrics for ER care and they may not always work well, argues Ashish Jha, MD, a practicing internist and Harvard health policy researcher...