Mission and Vision Statement
Vision: A transformed system in which the emergency department and its staff is a valued asset to the community, as a key component of a healthcare system that provides appropriate care, and that puts both individual and population health ahead of profits.
Mission: To build a partnership of emergency care providers and community members that empowers patients and health care staff to make informed, just decisions that improve overall health and well-being. We wish to foster timely, coordinated, patient-centered care that maximizes benefit and minimizes harm.
Current State of Emergency Care:
- More than 28% of all acute care visits occur in the emergency department, resulting in 5% of the nation’s physicians managing a quarter of the acute care delivered in the United States and more than half of the care delivered to the uninsured.1
- The Emergency Department is the key access point for the uninsured, underinsured, and the mentally ill. While the Emergency department is thus a critical element of our current healthcare system, it also provides a window into the most broken aspects of both that healthcare system and our communities.
- Overutilization in the Emergency Departments is common and includes overtesting, overdiagnosis, and overtreatment.2-4 Key contributing factors in the larger culture as well as in American medicine itself, include misaligned incentives that reward interventions rather than outcomes, a misguided belief that technological wizardry can solve all problems, a perpetual faith in early diagnosis with an expanding definition of “abnormal”, widespread intolerance of uncertainty, and weak literacy in medical evidence.2-8
- At the same time the Emergency Department is part of an overall health care system in which underutilization is also an important problem – particularly for marginalized groups for whom the ER is often the central provider of healthcare, such as the uninsured, underinsured, and mentally ill. Underutilization in the Emergency Department typically involves an inability to provide, or to arrange for, comprehensive care for ambulatory-care sensitive conditions that would be better treated with coordinated primary care.
- While appropriate critical care in the Emergency Department is an essential element in dealing with life- and limb-threatening illness, inappropriate high-intensity care can produce substantial harm, by at least two mechanisms. The ED decision to hospitalize a patient, and especially to initiate ICU care, is enormously expensive; when done in patients where this is not needed, it harms the overall system both in economic terms and in lost opportunity cost. Furthermore, unnecessary high intensity emergency department care is a leading cause of emergency department overcrowding, a crisis throughout the US, which in turn results in increased medical errors, worse outcomes, and further overcrowding.9
- Provide an advocacy venue for emergency physicians, nurses, physicians assistants, nurse practitioners, technicians, paramedics, EMTs, patients, and community partners concerned about inappropriate care fostered by a profit-driven system both in terms of overuse (overtesting, overdiagnosis, and overtreatment) and underuse in emergency settings.
- Highlight unnecessary care delivered in the Emergency Department and advocate for ways to break the cycle of overutilization that is based on current institutional, economic, and cultural incentives that inappropriately influence care.
- Promote shared decision-making in emergency care to incorporate the values, preferences, and circumstances of patients in their health care decisions. This could include, where appropriate, shared decision-making for advanced imaging, medical therapy, hospital admission and goals–of-care assessments, to help patients, families, and staff make decisions that are reasonable and congruent with patient values.
- Partner with the other Right Care Alliance Councils to promote clear inter-specialty care pathways and guidelines for common disease entities and presentations. This would promote coordinated, evidenced-based medical care in the right settings, at the right time, by the right providers.
- Advocate for enhancements in care coordination that assist patients in navigating the healthcare and social system and accessing the resources they need beyond the emergency department.
- Pitts SR, Carrier ER, Rich EC, Kellermann AL. Where Americans get acute care: increasingly, it’s not at their doctor’s office. Health Aff 2010;29:1620-9.
- Carpenter CR. Overdiagnosis: Fact Versus Fiction. In: Emergency Physicians Monthly. Baltimore, MD: Plaster Publishing; 2013.
- Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. BMJ 2012;344:e3502.
- Welch HG. Overdiagnosed: Making People Sick in the Pursuit of Health. Boston, MA: Beacon Press; 2011
- Hoffman JR, Cooper RJ. Overdiagnosis of disease: a modern epidemic. Arch Intern Med 2012;172:1123-4
- Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical industry and disease mongering. BMJ 2002;324:886-91.
- Katz MH, Grady D, Redberg RF. Undertreatment improves, but overtreatment does not. JAMA Intern Med 2013;173:93.
- Emanuel EJ, Fuchs VR. The perfect storm of overutilization. JAMA 2008;299:2789-991.
- Pitts SR, Pines JM, Handrigan MT, Kellermann AL. National trends in emergency department occupancy, 2001 to 2008: effect of inpatient admissions versus emergency department practice intensity. Ann Emerg Med 2012;60:679-86.
Erin E. Wilkes, MD, MSHS, FACEP
1) Emergency Medicine Clinician, Los Angeles, CA
2) Health Sciences Clinical Assistant Professor, Department of Emergency Medicine, UCLA David Geffen School of Medicine
3) Former Director of Emergency Medicine Innovation and Quality, Los Angeles County, Department of Health Services
Why I joined this council?
Our healthcare system is a mess, but I believe that there is a growing collective of people ready to fight for something better. It’s time to reform our medical education and healthcare delivery system to focus on outcomes, not workup and diagnosis; to gear our treatment of disease to improving the overall health of people; to employ the ever-growing body of evidence critically in real time; and to engage patients in informed decision making. In the process, I believe we can change the culture of medicine and healthcare and improve the well being of patients, communities, physicians, nurses and other healthcare providers.
Breena R. Taira, MD, MPH, CPH, FACEP
1) Health Sciences Clinical Assistant Professor, David Geffen UCLA School of Medicine
2) Research Director, Department of Emergency Medicine, Olive View-UCLA Medical Center
3) S. Director, Project SEMILLA
Why I joined the Council?
I joined the council because I believe that high quality emergency care should be available to all.
Tyler Warren Barrett
Robert B. Dunne
Mark A. Gendreau