In Boston, medical treatment for the more than 200 victims of the marathon bombing began within minutes of the terrorist attack, thanks to a well-orchestrated emergency response by everyone from ambulance drivers to emergency physicians. Emergency responders helped save the lives of scores of victims who arrived at local hospitals near death. Considering the devastation, the loss of life was astonishingly small. The scope of injuries was enormous to be sure, but so was the number of lives saved.
That terrible event shone a bright light on the extraordinary capabilities of a well-prepared, well-supported emergency medical care system.
What doesn't make headlines is the equally extraordinary work performed in our nation’s emergency departments on ordinary days, night and weekends. According to a new Rand Corp. survey, the 4 percent of America’s doctors who staff hospital emergency departments provide 11 percent of all the outpatient visits in the U.S., 28 percent of all acute care visits, half of the acute care visits by Medicaid and CHIP beneficiaries and two-thirds of all acute care visits by the uninsured. And all for a very small percentage of America’s healthcare dollar.
We also have become the go-to resource for primary care physicians who depend on emergency departments for complex diagnostic workups and facilitating admissions of acutely ill patients. The Rand study reports that four in five patients who contacted their doctor before seeking emergency care were told to bypass the office and go directly to the ER, which contradicts the common assumption that access to primary care will keep patients out of the emergency department. The finding also validates anecdotal reports by emergency physicians who treat growing numbers of patients with complex medical problems that cannot be solved by taking two aspirins and calling their doctor in the morning.
The entire country has agreed that healthcare costs must be reduced, but working out where exactly those cost savings come from has proven to be tricky. At the same time, all communities in the country should put as high a priority as Boston does on supporting their emergency systems, and not just because of the possibility of a mass casualty event.
On days when the unthinkable doesn't happen, emergency physicians still evaluate and manage nearly half of all hospital admissions, according to Rand. This is where the rubber meets the road when we talk about the high cost of healthcare: inpatient hospital care accounts for 31 percent of the nation’s healthcare expenses. Very often emergency physicians act as de facto care coordinators for their patients and make admission decisions based on what kind of support is available – or more importantly, isn’t available – to their patients once they leave the hospital.
There is a critical need for follow-up in our healthcare system. Emergency physicians can’t in good conscience send people home when they know they won’t be able to get their medications, don’t have any support from family or friends and can’t get follow-up medical visits.
Nobody has a better view on the healthcare system than emergency physicians. We see everybody, from babies to increasingly high numbers of seniors, and we see the full spectrum of medical problems that exist. The role ERs and emergency physicians play in deciding who to admit to the hospital is important, because the average cost of an inpatient stay ($9,200) is roughly 10 times the average cost of a comprehensive emergency visit. The Rand study recommends that hospital administrators, policymakers, payers and federal research agencies recognize the currently reality in emergency department operations and the valuable role they play in coordinating care for millions of patients.
This is a time of historic change, when everyone is asking: what does healthcare reform mean for me? We hope that you never need us, but emergency care has never been more important to us all than it is right now. Emergency physicians have special hours: all day, all night, all year.
The value of emergency medicine is obvious when a Boston or a Tucson or an Aurora tragedy happens. To us, it’s also obvious in the small miracles that happen every day in our nation’s ERs, the kind that don’t make the evening news but should.
Sama, a graduate of Columbia University, earned his medical degree from Cornell University Medical College. He is chairman of the department of emergency medicine at North Shore University Hospital, and president of the American College of Emergency Physicians.