Proposal for Departmental Status: Emergency Medicine. November, 2013

November, 2013

Proposal for Departmental Status:

Emergency Medicine

•

Emergency Medicine – national context

•

Emergency Medicine – at UW Health

•

1960: Emergency Medicine conceived

•

1970: 1

_{Emergency Medicine residency at}

University of Cincinnati

•

1980: 1

_{Emergency Medicine board examination}

by American Board of Emergency Medicine

•

1989: Emergency Medicine

recognized as

primary board

by

American Board of Medical Specialties

History of

•

Increasing patient visit

volumes

– Insured > Uninsured

•

Increasing patient

acuity

–

Aging demographics

–

Surviving with more

co-morbidities

•

Increasing number of

early therapies &

early interventions

–

MI, Trauma

–

CVA, AAA, Sepsis

•

Increasing inpatient and

outpatient

capacity

constraints

–

Increased intensity

of care in the ED

(labs, rads, consults).

Larson et al. National Trends in CT Use in the Emergency Department: 1995–2007. _{Radiology. 2010.}

Results: Over the study period, ICU admissions from EDs

increased from 2.79 million in 2002/2003, to 4.14 million in

2008/2009, an absolute increase of 48.8% and a mean biennial increase of 14.2%. By comparison, overall ED visits increased a mean of 5.8% per biennial period. The three most common diagnoses for ICU admissions were unspecified chest pain, congestive heart failure, and pneumonia.

In the 1990s,

59%



in

critical

care

visits,

36%



in

urgent

visits, and

8%



in

nonurgent

visits to California

EDs*

Lambe S et al. Trends in the use and capacity of California’s Emergency Departments, 1990-1999. Ann Emerg Med. 2002.

39: 389-396

ED Expect Note

Jun 14, 2004 2:34pm

Here in office, 86 yo woman s/p mitral and tricuspid valve repair w/ ongoing CHF, s/p recurrent lower GI bleeding, here w/ fatigue, dyspnea on exertion, and some abd pain. Not orthostatic. Appears in failure. Possible R

inguinal hernia. Hct has decreased to 23. Please assess.

Likely need labs, abd/pelvis CT, transfusion, diuresis, surg consult, and med admit.

Greatest increase in visits due to

*Unaccredited Fellowships

14

2 3 4 5 6

7 8 12

13 16 19 22

26 35

42 47

53 54 57

59 61 65

66

72 73 74 77 0 10 20 30 40 50 60 70 80 90

Growth of Academic Departments

of Emergency Medicine

96/108 = 89%

10 remaining divisions - AACEM

Illinois @ Chicago – DEPARTMENT Iowa – DEPARTMENT

Indiana – DEPARTMENT Michigan – DEPARTMENT

Michigan State – Division (no residency) Minnesota – DEPARTMENT (no residency) Nebraska – DEPARTMENT

Northwestern – DEPARTMENT Ohio State – DEPARTMENT

Penn State – DEPARTMENT Wisconsin - Division

17

Institution

Year of Dept.

University of Pennsylvania Johns Hopkins University University of Pittsburgh Emory University

University of Michigan Northwestern University Brown University

University of California - San Francisco Yale University 1994 1994 1995 1998 1999 2004 2004 2008 2009

Top Ranking Programs

Overall Patient Visit

Volume Growth

Admit 30% of ED patients

UW Emergency Medicine

Program Chart

UW Emergency Medicine

Committee Chart

UW Emergency Medicine

Organization Chart

UW Emergency Medicine

Residency Size

•

Formal Division of Emergency Medicine faculty vote

• 4/23/2013 - unanimous

•

Formal Department of Medicine

Executive Committee vote

• 6/17/2013 – one abstention

•

_{UWSMPH candidate department designation}

• 7/1/2013

•

UWSMPH Council of Chairs vote

• 7/8/2013 – unanimous

•

UWSMPH Academic Planning Committee vote

• 9/18/2013 – unanimous

•

UW-Madison Academic Planning Committee vote

• 10/24/2013 – pending

•

Central hub

in health care delivery

system, especially in

accountable

care organization

with medical

homes

–

in collaboration with other providers,

address patient needs, ranging from

acute

to

non-acute

to

social services

to

end of life/palliative care

•

Central hub

of multidisciplinary

teaching and collaborative research

–

Multidisciplinary learners

• Medical, PA, EMT, Pharmacy, & Nursing students, over 80 per year

• EM & non-EM residents, over 70 per year

–

Collaborative research

• Medical, Nursing, & Pharmacy

• Departments of Radiology,

Neurology/Neurosurgery, Trauma Surgery

•

Increasing Needs; Decreasing Resources

– Increased number of insured; healthcare reform

– Decreased resources; resident duty hours

– Increased capacity constraints; inpatient and outpatient

•

Increasing scope of responsibility & liability

– Sedation and procedures in ED

– Readmission penalties

•

Physical space needs

– Clinical space (ED Clinical Decision Unit, ED – MRI)

– Administrative space

•

Recruitment challenges

– NP/PA